Healthcare Provider Details

I. General information

NPI: 1578839890
Provider Name (Legal Business Name): SUNCOAST PACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6774 102ND AVE N
PINELLAS PARK FL
33782-2909
US

IV. Provider business mailing address

5771 ROOSEVELT BLVD
CLEARWATER FL
33760-3407
US

V. Phone/Fax

Practice location:
  • Phone: 727-289-0062
  • Fax:
Mailing address:
  • Phone: 727-586-4432
  • Fax: 727-523-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAIDA BOUHAMID
Title or Position: CFO
Credential:
Phone: 727-523-3339