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NPI Code Detail

MEDICARE: PACE OF SOUTHWEST MICHIGAN INC

MEDICARE: PACE OF SOUTHWEST MICHIGAN INC
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
1251T00000XPACE Provider Organization

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568709392
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACE OF SOUTHWEST MICHIGAN INC
Provider Business Mailing Address
First Line : 2900 LAKEVIEW AVE
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-2379
Country : US
Telephone Number : 269-408-4322
Fax Number : 269-408-4340
Provider Business Practice Location Address
First Line : 2900 LAKEVIEW AVE
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-2379
Country : US
Telephone Number : 269-408-4322
Fax Number : 269-408-4340
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : THERESE SAGGAU
Credential :
Telephone Number : 269-408-4322
Provider Enumeration Date : 01/14/2013
Last Update Date : 05/14/2013

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Directions to “PACE OF SOUTHWEST MICHIGAN INC ” Practice Location

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