Provider Demographics
NPI:1265293823
Name:LIFE COORDINATED COMMONWEALTH PACE INC
Entity type:Organization
Organization Name:LIFE COORDINATED COMMONWEALTH PACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:EVERITT
Authorized Official - Suffix:
Authorized Official - Credentials:PMP
Authorized Official - Phone:615-376-4677
Mailing Address - Street 1:PO BOX 2403
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2403
Mailing Address - Country:US
Mailing Address - Phone:615-376-4677
Mailing Address - Fax:
Practice Address - Street 1:201 E 11TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1515
Practice Address - Country:US
Practice Address - Phone:866-878-1121
Practice Address - Fax:855-868-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251B00000XAgenciesCase Management