NPIMap

Organization Active NPI

Pacific Home Care Associates, Inc.

  • Community Based Hospice Care Agency
  • Coos Bay, OR
National Provider Identifier
1124112784
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PACIFIC HOME CARE ASSOCIATES, INC.
Practice address
375 Park Ave Ste 6
Coos Bay, OR 97420-2242
Phone
(541) 266-7005
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Donald A Freeman
Title
President
Phone
(405) 878-0202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X OR Primary

Addresses

Primary practice location

375 Park Ave Ste 6
Coos Bay, OR 97420-2242

Mailing address

120 W Macarthur St Ste 121
Shawnee, OK 74804-2005
Phone (405) 878-0202

Other names 1

  • Pacific Home Health and Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080911000147 OR Part A Provider - Hospice 3971513722 Practice locations: Coos Bay, OR

Hospice certification: CCN 381524

Legal name
PACIFIC HOME CARE ASSOCIATES, INC.
Doing business as
PACIFIC HOME HEALTH AND HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 5, 1992
Last certification
Apr 22, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Jul 12, 1996 in OR
Enrollment address
375 Park Ave
Ste 6
Coos Bay, OR 97420-2242

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Pacific Home Health & HospiceCCN 381524
Ownership
For-Profit
Certified
Jun 5, 1992
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Pacific Home Care Associates4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Donald a Freeman Individual 5% Or Greater Direct Ownership Interest Oct 1, 2006 100%
Troy a Cribbins Individual W-2 Managing EmployeeAdministrator Jan 14, 2019
Preferred Management Corporation Organization, Shawnee, OK Operational/Managerial Control Jul 12, 1996
Luke Campbell Individual Corporate OfficerVP of Finance Feb 1, 2025
Jared Chanski Individual Corporate OfficerExecutive Vice President Jan 1, 2020
Josh Tucker Individual Corporate OfficerHospital Cfo Jan 1, 2020
Rajesh Ravuri Individual Contracted Managing EmployeeMD; Jul 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 35

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 35

Practitioners & affiliated clinicians

Affiliated clinicians 10

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1124112784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W MACARTHUR ST STE 121",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748042005",
            "telephone_number": "405-878-0202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 PARK AVE STE 6",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202242",
            "telephone_number": "541-266-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HOME CARE ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-878-0202",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Home Health and Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Home Health and Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coos Bay, OR

Sources for this page

Verify at the official NPI Registry.