Pacific Home Care, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

201122200526 Issued in OH

Legal business name

PACIFIC HOME CARE, LLC

Practice address

4713 W 130TH St
Cleveland, OH 44135-3705

Phone

(216) 458-5756

Fax

(216) 812-1121

NPI assigned

Aug 11, 2011

Organization subpart

No

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

Authorized official

Name

Abdullahi A Ali

Title

Manager

Phone

(216) 396-5051

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Home health agency certification: CCN 368469

Legal name

PACIFIC HOME CARE, LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Dec 1, 2012

Last certification

Oct 11, 2018

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Aug 8, 2011 in OH

Enrollment address

4713 W 130TH St
Cleveland, OH 44135-3705
HHA Branch

Listed as

Pacific Home Care LLCCCN 368469

Ownership

Proprietary

Certified

Dec 1, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1730468448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 W 130TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441353705",
            "telephone_number": "216-458-5756",
            "fax_number": "216-812-1121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 W 130TH ST",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441353705",
            "telephone_number": "216-458-5756",
            "fax_number": "216-812-1121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "ABDULLAHI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "216-396-5051"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OH",
            "license": "201122200526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Matthew Pacheco, MD
• Elizabeth A Pacheco, CNP
• Kiomara Pacheco
• Rachael L Pachuta, CNS
• Sandra Paci, APRN
• Pacific Transportation Services, LLC
• Mariea Pack-Elder
• Tabitha Packard, APRN-CNP
• Clifford Decatur Packer, MD
• Kamya Packer

• Home Health Agency in Cleveland, OH
• Providers in Cleveland, OH by specialty
• Home Health Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.