Healthcare Provider Details

I. General information

NPI: 1255601142
Provider Name (Legal Business Name): PACE HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 SIERRA DR
MIAMI FL
33179-3266
US

IV. Provider business mailing address

25 SIERRA DR
MIAMI FL
33179-3266
US

V. Phone/Fax

Practice location:
  • Phone: 305-343-9812
  • Fax:
Mailing address:
  • Phone: 305-343-9812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: HENRIETTA JO PACE
Title or Position: OWNER
Credential:
Phone: 305-343-9812