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General NPI Number Information
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NPI Number | 1255202255
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Entity Type | Organization
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Legal Business Name | PACE HEALING CENTER
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 11706 WYNNIFRED PL
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City | GLENN DALE
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State | MD
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Zip | 20769-9482
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Country | US
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Telephone | 240-422-4768
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Fax |
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Provider Business Mailing Address
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Address Line | 11706 WYNNIFRED PL
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City | GLENN DALE
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State | MD
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Zip | 20769-9482
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | FATMATA TEJAN
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Credential |
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Telephone | 124-042-2476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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