Provider Demographics
NPI:1568709392
Name:PACE OF SOUTHWEST MICHIGAN INC
Entity Type:Organization
Organization Name:PACE OF SOUTHWEST MICHIGAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGGAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-408-4322
Mailing Address - Street 1:2900 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-2379
Mailing Address - Country:US
Mailing Address - Phone:269-408-4322
Mailing Address - Fax:269-408-4340
Practice Address - Street 1:2900 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2379
Practice Address - Country:US
Practice Address - Phone:269-408-4322
Practice Address - Fax:269-408-4340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2332863OtherMEDICAID BILLING AGENT ID
MI2331543Medicaid