MEDICARE: PACE TRAINING AND EVALUATION CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	05357001	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356449375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACE TRAINING AND EVALUATION CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 4241
Second Line	:	420 PLEASANT HILLS AVE
City	:	STAR CITY
State	:	WV
Zip	:	26504-4241
Country	:	US
Telephone Number	:	304-599-0513
Fax Number	:	304-599-0671

Provider Business Practice Location Address
First Line	:	420 PLEASANT HILL AVE
Second Line	:
City	:	STAR CITY
State	:	WV
Zip	:	26505-2042
Country	:	US
Telephone Number	:	304-599-0513
Fax Number	:	304-599-0671

Authorized Official
Title or Position	:	CLIENT SERVICES MANAGER
Name	:	MR. JEFFREY WAYNE BELL
Credential	:
Telephone Number	:	304-599-0513

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/22/2020

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