Healthcare Provider Details

I. General information

NPI: 1891486254
Provider Name (Legal Business Name): VALLEY PACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4837 EAST MCKINLEY AVENUE
FRESNO CA
93703
US

IV. Provider business mailing address

106 W MOORE AVE STE A
MOORESVILLE NC
28115-3552
US

V. Phone/Fax

Practice location:
  • Phone: 732-806-3223
  • Fax: 732-806-3323
Mailing address:
  • Phone: 732-806-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL Y CZERMAK
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 855-801-2653