Provider Demographics
NPI:1568720845
Name:PACE SUPPORTIVE LIVING, LLC.
Entity Type:Organization
Organization Name:PACE SUPPORTIVE LIVING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:OSEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-373-6943
Mailing Address - Street 1:6886 LABURNUM DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8596
Mailing Address - Country:US
Mailing Address - Phone:614-862-0782
Mailing Address - Fax:614-862-0783
Practice Address - Street 1:6886 LABURNUM DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8596
Practice Address - Country:US
Practice Address - Phone:614-862-0782
Practice Address - Fax:614-862-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2559995OtherDODD CONTRACT NUMBER
OH0075198Medicaid