Provider Demographics
NPI:1124750617
Name:PACE HEALTHCARE LLC
Entity type:Organization
Organization Name:PACE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-855-4709
Mailing Address - Street 1:5225 CLEVELAND RD STE F
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5541
Mailing Address - Country:US
Mailing Address - Phone:330-625-4900
Mailing Address - Fax:330-685-9355
Practice Address - Street 1:101 5TH ST SE STE D
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4225
Practice Address - Country:US
Practice Address - Phone:330-625-4900
Practice Address - Fax:330-685-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty