MEDICARE: CORNERSTONE PACE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251T00000X	PACE Provider Organization

General Provider Information

NPI Number	:	1518401017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORNERSTONE PACE LLC

Provider Business Mailing Address
First Line	:	2445 LANE PARK RD
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-9648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 S ORANGE AVE
Second Line	:	SUITE 5665
City	:	ORLANDO
State	:	FL
Zip	:	32809-4229
Country	:	US
Telephone Number	:	888-728-6234
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	STEPHANIE SCARBROUGH
Credential	:
Telephone Number	:	352-742-6777

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	12/19/2016

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Directions to “CORNERSTONE PACE LLC ” Practice Location

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