Provider Demographics
NPI:1508693052
Name:PACE BEHAVIORAL HEALTH CARE LLC
Entity type:Organization
Organization Name:PACE BEHAVIORAL HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CFO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KICHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-502-6723
Mailing Address - Street 1:6051 TURKEY HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-6963
Mailing Address - Country:US
Mailing Address - Phone:804-502-6723
Mailing Address - Fax:804-251-3761
Practice Address - Street 1:3663 N SAM HOUSTON PKWY E STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3611
Practice Address - Country:US
Practice Address - Phone:804-502-6723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health