MEDICARE: PACIFICSOURCE PACE, LLC

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	251T00000X	PACE Provider Organization

General Provider Information

NPI Number	:	1720944655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFICSOURCE PACE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 70071
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97475-0104
Country	:	US
Telephone Number	:	425-214-2526
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 INTERNATIONAL WAY STE B104
Second Line	:
City	:	SPRINGFIELD
State	:	OR
Zip	:	97477-6013
Country	:	US
Telephone Number	:	458-544-0400
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. ELLEN MAE GARCIA
Credential	:	MPH
Telephone Number	:	425-214-2526

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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