Provider Demographics
NPI:1972476877
Name:PACE NORTHEAST MICHIGAN
Entity type:Organization
Organization Name:PACE NORTHEAST MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-204-8210
Mailing Address - Street 1:2676 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4620
Mailing Address - Country:US
Mailing Address - Phone:989-358-4833
Mailing Address - Fax:989-963-4968
Practice Address - Street 1:2676 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4620
Practice Address - Country:US
Practice Address - Phone:989-358-4833
Practice Address - Fax:989-963-4968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization