Provider Demographics
NPI:1427598713
Name:COMMUNITY PACE AT HOME, INC
Entity Type:Organization
Organization Name:COMMUNITY PACE AT HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEESTMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-652-4618
Mailing Address - Street 1:231 W PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-9264
Mailing Address - Country:US
Mailing Address - Phone:616-617-7565
Mailing Address - Fax:
Practice Address - Street 1:231 W PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9264
Practice Address - Country:US
Practice Address - Phone:616-617-7565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization