Provider Demographics
NPI:1871310532
Name:PACIFICA CARE OF SUNCOAST, LLC
Entity type:Organization
Organization Name:PACIFICA CARE OF SUNCOAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREESH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-221-2232
Mailing Address - Street 1:13121 ATLANTIC BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-0102
Mailing Address - Country:US
Mailing Address - Phone:904-221-2232
Mailing Address - Fax:
Practice Address - Street 1:24451 SANDHILL BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5214
Practice Address - Country:US
Practice Address - Phone:941-347-8447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health