Provider Demographics
NPI:1538171236
Name:PCC HEALTH SERVICES INC
Entity type:Organization
Organization Name:PCC HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:PADRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-248-9808
Mailing Address - Street 1:2258 FOOTHILL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1476
Mailing Address - Country:US
Mailing Address - Phone:818-248-9808
Mailing Address - Fax:818-541-7072
Practice Address - Street 1:1495 W CAMERON AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2710
Practice Address - Country:US
Practice Address - Phone:626-962-4461
Practice Address - Fax:626-962-2903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950000009314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALTC062281Medicaid
CALTC062281Medicaid