Provider Demographics
NPI:1407736135
Name:PACIFIC HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:PACIFIC HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REMIGIUS
Authorized Official - Middle Name:IMIMOLE
Authorized Official - Last Name:IDAEWOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-480-5315
Mailing Address - Street 1:4625 E BROADWAY BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3576
Mailing Address - Country:US
Mailing Address - Phone:678-480-5315
Mailing Address - Fax:678-669-1693
Practice Address - Street 1:4625 E BROADWAY BLVD STE 218
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3576
Practice Address - Country:US
Practice Address - Phone:678-480-5315
Practice Address - Fax:678-669-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty