Organization
LIFE COORDINATED COMMONWEALTH PACE INC
Active
Other names
LIFE COORDINATED Senior Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY C EVERITT PMP (CEO)
(615) 376-4677
Entity
Organization
Contact information
Practice address
201 E 11TH ST, BENTON, KY 42025-1515
(855) 209-5451
Mailing address
PO BOX 2403, BRENTWOOD, TN 37024-2403
(615) 376-4677
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/29/2024
Last updated
10/29/2024
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