Provider Demographics
NPI:1871638023
Name:PACIFIC, INC.
Entity type:Organization
Organization Name:PACIFIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATEMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:PANAHI
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:303-377-8833
Mailing Address - Street 1:1595 HARLAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-1535
Mailing Address - Country:US
Mailing Address - Phone:303-237-0941
Mailing Address - Fax:303-237-0942
Practice Address - Street 1:1595 HARLAN ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-1535
Practice Address - Country:US
Practice Address - Phone:303-237-0941
Practice Address - Fax:303-237-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42-39832-0000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77601319Medicaid