Provider Demographics
NPI:1629813498
Name:PACE AT HUDSON HEADWATERS
Entity type:Organization
Organization Name:PACE AT HUDSON HEADWATERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE AND CONTR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOXLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-886-7213
Mailing Address - Street 1:38 LAROSE ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4025
Mailing Address - Country:US
Mailing Address - Phone:518-886-7213
Mailing Address - Fax:
Practice Address - Street 1:38 LAROSE ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4025
Practice Address - Country:US
Practice Address - Phone:518-886-7213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization