Provider Demographics
NPI:1255601142
Name:PACE HEALTH SYSTEMS
Entity type:Organization
Organization Name:PACE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-343-9812
Mailing Address - Street 1:25 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3266
Mailing Address - Country:US
Mailing Address - Phone:305-343-9812
Mailing Address - Fax:
Practice Address - Street 1:25 SIERRA DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3266
Practice Address - Country:US
Practice Address - Phone:305-343-9812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1255601142Medicaid
FL1255601142Medicare Oscar/Certification
FL1255601142Medicare NSC
FL1255601142Medicare PIN
FL1255601142Medicaid