Provider Demographics
NPI:1669639274
Name:CHANGE OF PACE RETIREMENT CENTER INC
Entity Type:Organization
Organization Name:CHANGE OF PACE RETIREMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-629-8990
Mailing Address - Street 1:1715 E SILVER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6922
Mailing Address - Country:US
Mailing Address - Phone:352-629-8990
Mailing Address - Fax:352-629-8990
Practice Address - Street 1:1715 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6922
Practice Address - Country:US
Practice Address - Phone:352-629-8990
Practice Address - Fax:352-629-8990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL53310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140253600Medicaid