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General NPI Number Information
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NPI Number | 1427598713
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Entity Type | Organization
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Legal Business Name | COMMUNITY PACE AT HOME, INC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 231 W PINE LAKE DR
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City | NEWAYGO
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State | MI
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Zip | 49337-9264
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Country | US
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Telephone | 616-617-7565
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Fax |
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Provider Business Mailing Address
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Address Line | 231 W PINE LAKE DR
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City | NEWAYGO
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State | MI
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Zip | 49337-9264
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Country | US
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Telephone | 616-617-7565
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | AARON LEESTMA
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Credential |
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Telephone | 231-652-4618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number |
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License Number State |
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