Provider Demographics
NPI:1548305329
Name:PACIFIC RESPIRATORY CARE INC.
Entity type:Organization
Organization Name:PACIFIC RESPIRATORY CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:EUDALEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-596-1375
Mailing Address - Street 1:1415 W CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1731
Mailing Address - Country:US
Mailing Address - Phone:303-237-0941
Mailing Address - Fax:303-302-2214
Practice Address - Street 1:1415 W CEDAR AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-1731
Practice Address - Country:US
Practice Address - Phone:303-237-0941
Practice Address - Fax:303-302-2214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332BX2000X
COPSY0002910103T00000X, 106H00000X, 103TC1900X, 101Y00000X, 103TC2200X, 103TF0000X, 103TH0004X, 101YP2500X, 103TA0700X, 101YM0800X
COPSY0002010103T00000X
332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & SuppliesGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74570579Medicaid
CO20146000524OtherCOLORADO SECRETARY OF STATE
458243OtherJCAHO
CO20146000524OtherCOLORADO SECRETARY OF STATE