Provider Demographics
NPI:1104787704
Name:PACIFICSOURCE PACE, LLC
Entity type:Organization
Organization Name:PACIFICSOURCE PACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:425-214-2526
Mailing Address - Street 1:555 INTERNATIONAL WAY STE B104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-6013
Mailing Address - Country:US
Mailing Address - Phone:425-214-2526
Mailing Address - Fax:
Practice Address - Street 1:555 INTERNATIONAL WAY STE B104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-6013
Practice Address - Country:US
Practice Address - Phone:425-214-2526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-21
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization