Provider Demographics
NPI:1114322526
Name:PACE ENTERPRISES OF WEST VIRGINIA
Entity Type:Organization
Organization Name:PACE ENTERPRISES OF WEST VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:MR
Authorized Official - First Name:C
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-983-7223
Mailing Address - Street 1:889 MYLAN PARK LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2413
Mailing Address - Country:US
Mailing Address - Phone:304-983-7223
Mailing Address - Fax:304-983-2441
Practice Address - Street 1:889 MYLAN PARK LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2413
Practice Address - Country:US
Practice Address - Phone:304-983-7223
Practice Address - Fax:304-983-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005357000OtherWV MEDICAID MMIS PROVIDER ID NUMBER
WV1356449375OtherNPI NUMBER