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Organization

LIFE COORDINATED COMMONWEALTH PACE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. NANCY C EVERITT PMP (CEO)
(615) 376-4677
Entity
Organization

Contact information

Practice address
201 E 11TH ST, BENTON, KY 42025-1515
(866) 878-1121
(855) 868-3271
Mailing address
PO BOX 2403, BRENTWOOD, TN 37024-2403
(615) 376-4677

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251T00000X
PACE Provider Organization
Primary

Other

Enumeration date
01/22/2024
Last updated
01/22/2024
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