Provider Demographics
NPI:1811207889
Name:PACE IOWA
Entity Type:Organization
Organization Name:PACE IOWA
Other - Org Name:IMMANUEL PATHWAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF COMMUNITY OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-829-2954
Mailing Address - Street 1:6757 NEWPORT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2262
Mailing Address - Country:US
Mailing Address - Phone:402-829-2900
Mailing Address - Fax:402-829-2939
Practice Address - Street 1:1702 N 16TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-0121
Practice Address - Country:US
Practice Address - Phone:712-256-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMANUEL HOME AND COMMUNITY RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization