Provider Demographics
NPI:1053198457
Name:PACIFIC COAST HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:PACIFIC COAST HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENEDICTA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:OGOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-487-5674
Mailing Address - Street 1:13658 HAWTHORNE BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5814
Mailing Address - Country:US
Mailing Address - Phone:310-487-5674
Mailing Address - Fax:310-861-1469
Practice Address - Street 1:13658 HAWTHORNE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5814
Practice Address - Country:US
Practice Address - Phone:310-487-5674
Practice Address - Fax:310-861-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health