Pacific Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

036467 Issued in MO

Legal business name

PACIFIC CARE CENTER LLC

Practice address

105 South Sixth Street
Pacific, MO 63069

Phone

(636) 271-4222

Fax

(636) 257-8002

NPI assigned

Mar 25, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Gretchen R Roberts-Hoaglin, R.N. LICENSED NURSIN

Title

Administrator

Phone

(636) 271-4222

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1237939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351036800000",
    "number": "1801038724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 SOUTH SIXTH STREET",
            "city": "PACIFIC",
            "state": "MO",
            "postal_code": "63069",
            "telephone_number": "636-271-4222",
            "fax_number": "636-257-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 SOUTH SIXTH STREET",
            "city": "PACIFIC",
            "state": "MO",
            "postal_code": "63069",
            "telephone_number": "636-271-4222",
            "fax_number": "636-257-8002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-25",
        "last_updated": "2012-10-24",
        "status": "A",
        "authorized_official_last_name": "ROBERTS-HOAGLIN",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "636-271-4222",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N. LICENSED NURSIN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "036467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102343001",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Pacific, MO
• Providers in Pacific, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2012; 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.