PACIFICA SYLVAN PARK LLC (NPI# 1285291849) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285291849 |
| Entity Type | Organization |
| Organization Name | PACIFICA SYLVAN PARK LLC |
| Practice Address |
2400 Ne 112th Avenue Vancouver WA 98684 |
| Mailing Address |
1775 Hancock Street Suite 200 San Diego CA 92110 |
| Practice Telephone | 3606195245 |
| Practice Fax Number | 3603261851 |
| Mailing Telephone | 6192969000 |
| Mailing Fax Number | 6192969090 |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-05-20 |
| Authorized Official Name | DEEPAK ISRANI (GENERAL MANAGER) |
| Authorized Official Telephone | 6192969000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 311500000X | Alzheimer Center (Dementia Center) | Nursing & Custodial Care Facilities | ||
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Pacifica Senior Living Vancouver | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | PACIFICA SYLVAN PARK LLC | 1775 Hancock St #200, San Diego, CA 92110 |
| Street Address |
2400 NE 112TH AVENUE |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98684 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699242826 | Heidi Ericka Jackson | Registered Nurse | 15606 Ne 12th Way, Vancouver, WA 98684 | 2018-10-25 |
| 1477076727 | Brian Benasa Bardeloza | Dentist | 605 Se 164th Ave Ste 103, Vancouver, WA 98684 | 2017-07-19 |
| 1992226062 | Judith Moreno-castro | Massage Therapist | 2501 Ne 138th Ave., #60, Vancouver, WA 98684 | 2017-06-29 |
| 1346790706 | Samuel Joonsang Lee | Registered Nurse | 501 Se 172nd Ave Ste 210, Vancouver, WA 98684 | 2016-10-10 |
| 1912353178 | Cheryl A. Hamilton-jefferson | Counselor | 11818 Se Mill Plain Blvd Ste 311g, Vancouver, WA 98684 | 2016-05-06 |
| 1063866424 | Kim Forgione | Optometrist | 1900 Ne 162nd Ave Ste D103, Vancouver, WA 98684 | 2016-04-21 |
| 1700254257 | Desiree Haggart | Registered Nurse | 406 Se 131st St., Suite A101, Vancouver, WA 98684 | 2015-09-14 |
| 1215318068 | Paige M. King | Behavioral Analyst | 11818 Se Mill Plain Blvd Ste 203, Vancouver, WA 98684 | 2015-06-17 |
| 1417354366 | Amanda Hilkey, Lmp | Massage Therapist | 108 Se 24th Ave, Ste 9, Vancouver, WA 98684 | 2014-11-20 |
| 1174954911 | Susan Louise Kelsay | Marriage & Family Therapist | 201 Se 124th Ave., #203, Vancouver, WA 98684 | 2013-12-04 |
| Find all providers in zip 98684 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114494432 | Columbia Vista Afh Inc | Assisted Living Facility | 7418 Se Evergreen Hwy, Vancouver, WA 98664-1718 | 2018-10-24 |
| 1629517529 | Ai Helmer | Assisted Living Facility | 13011 Ne 71st St, Vancouver, WA 98682-4861 | 2017-02-13 |
| 1427490887 | Riverside Afh | Assisted Living Facility | 7410 Se Evergreen Hwy, Vancouver, WA 98664-1718 | 2013-07-25 |
| 1912271289 | Retirement Centers Northwest Inc | Assisted Living Facility | 7808 Ne 51st St, Vancouver, WA 98662-6207 | 2012-03-02 |
| 1518239409 | Merrill Gardens, LLC | Assisted Living Facility | 10011 Ne 118th Ave, Vancouver, WA 98682-2784 | 2012-02-07 |
| 1043582208 | Windsor Gardens Inc. | Assisted Living Facility | 1602 Ne 162nd Ave, Vancouver, WA 98684-9426 | 2012-02-03 |
| 1790066793 | Glenwood Place Senior Living, LLC | Assisted Living Facility | 5500 Ne 82nd Ave, Vancouver, WA 98662-9410 | 2011-09-02 |
| 1447584594 | Park Lido, Inc. | Assisted Living Facility | 8422 Ne 8th Way, Vancouver, WA 98664-1974 | 2009-09-22 |
| 1992825921 | Vancouver Senior Living, LLC | Assisted Living Facility | 17171 Se 22nd Dr, Vancouver, WA 98683-3309 | 2007-03-31 |
| 1457477994 | Assisted Living Concepts Inc | Assisted Living Facility | 2610 Se 164th Avenue, Vancouver, WA 98683 | 2007-03-22 |
| Find all providers in VANCOUVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.