Provider Demographics
NPI:1487476636
Name:LIFE COORDINATED COMMONWEALTH PACE INC
Entity type:Organization
Organization Name:LIFE COORDINATED COMMONWEALTH PACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:EVERITT
Authorized Official - Suffix:
Authorized Official - Credentials:PMP
Authorized Official - Phone:615-376-4677
Mailing Address - Street 1:PO BOX 2403
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2403
Mailing Address - Country:US
Mailing Address - Phone:615-376-4677
Mailing Address - Fax:
Practice Address - Street 1:201 E 11TH ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-1515
Practice Address - Country:US
Practice Address - Phone:855-209-5451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care