Provider Demographics
NPI:1851950620
Name:PACE PARTNERS OF NORTHEAST FLORIDA, INC.
Entity Type:Organization
Organization Name:PACE PARTNERS OF NORTHEAST FLORIDA, INC.
Other - Org Name:PACE PLACE AND THE PACE PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PONDER-STANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-268-5200
Mailing Address - Street 1:5450 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-4750
Mailing Address - Country:US
Mailing Address - Phone:904-407-5050
Mailing Address - Fax:904-407-8123
Practice Address - Street 1:5450 RAMONA BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4750
Practice Address - Country:US
Practice Address - Phone:904-407-6207
Practice Address - Fax:904-407-8199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization