# AGEWELL PACE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437833597
- **Authorized official:** DERRICK WHITACRE (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (707) 615-4437

## Contact information

- **Practice address:** 5789 STATE FARM DR STE 110, ROHNERT PARK, CA 94928-6308
- **Practice address phone:** (707) 615-4437
- **Practice address fax:** (707) 615-6955
- **Mailing address:** 5789 STATE FARM DR STE 110, ROHNERT PARK, CA 94928-6308
- **Mailing address phone:** (707) 615-4437
- **Mailing address fax:** (707) 615-6955

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 06/09/2023
- **Last updated:** 06/09/2023