PACIFIC BREEZE AFH LLC
NPI 1043157324
Custodial Care Facility - Adult Care Home in Vancouver, WA
NPI Status: Active since May 04, 2026
Contact Information
16017 NE 79TH WAY
VANCOUVER, WA
ZIP 98682
Phone: (360) 605-8930
Fax: (360) 251-0313
- Organization
- Custodial Care Facility
- Adult Care Home
- CLIA Number: 50D2332797
- CLIA Cert. Type: Other - AFH
- CLIA Exp. Date: 04-04-2028
About PACIFIC BREEZE AFH LLC
This page provides the complete NPI Profile along with additional information for Pacific Breeze Afh Llc, a provider established in Vancouver, Washington operating as a Custodial Care Facility, focusing in adult care home . The healthcare provider is registered in the NPI registry with number 1043157324 assigned on May 2026. The practitioner's primary taxonomy code is 311ZA0620X. The provider is registered as an organization and their NPI record was last updated May 2026. The authorized official of this NPI record is Habte Simon Pharmd (Resident Manager)
- NPI
- 1043157324
- Provider Name
- PACIFIC BREEZE AFH LLC
- Entity Type
- Organization
- Location Address
- 16017 NE 79TH WAY VANCOUVER, WA 98682
- Location Phone
- (360) 605-8930
- Location Fax
- (360) 251-0313
- Mailing Address
- 16017 NE 79TH WAY VANCOUVER, WA 98682
- Mailing Phone
- (360) 605-8930
- Mailing Fax
- (360) 251-0313
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 05-04-2026
- Last Update Date
- 05-04-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Custodial Care Facility Adult Care Home
- Taxonomy Code
- 311ZA0620X
- Type
- Nursing & Custodial Care Facilities
- Taxonomy Description
- A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 50D2332797
- Facility Type
- Other - AFH
- Certificate Effective Date
- October 24, 2025
- Certificate Expiration Date
- April 04, 2028
- Laboratory Director
- HABTE M. SIMON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Pacific Breeze Afh Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1043157324, we treat the final digit (4) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 56 is 60. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1043157324, enumerated as an "organization" on May 04, 2026.
The provider is located at 16017 NE 79TH WAY VANCOUVER, WA 98682 and the phone number is (360) 605-8930.
Custodial Care Facility with taxonomy code 311ZA0620X and a focus in Adult Care Home.
