Pacifica Walton Beach LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

PACIFICA WALTON BEACH LLC

Practice address

1001 Mar Walt Dr
Fort Walton Beach, FL 32547-6780

Phone

(850) 863-5174

NPI assigned

Oct 22, 2020

Organization subpart

No

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

Authorized official

Name

Deepak Israni

Title

Owner

Phone

(619) 296-9000

Specialties & licenses 1

Addresses

Other names 1

• Meridian At Westwood Doing business as

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

{
    "created_epoch": "1603324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603324800000",
    "number": "1245839059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476780",
            "telephone_number": "850-863-5174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476780",
            "telephone_number": "850-863-5174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA WALTON BEACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-22",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A",
        "authorized_official_last_name": "ISRANI",
        "authorized_official_first_name": "DEEPAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-296-9000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian At Westwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cheryl Anne Owens, PHARM D
• Leah Antoinette Owens, MS, CCM
• Naomi Ozbun
• Meagan M Ozee, PT
• Vamsi Krishna Pachchipulusu, M.D
• Susan Page
• Precious Palmer
• Panama City Pulmonary LLC
• Jasmine Pang
• Destinee Panti, RBT

• Assisted Living Facility in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.