Organization
PACE OF SOUTHWEST MICHIGAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESE SAGGAU (EXECUTIVE DIRECTOR)
(269) 408-4322
Entity
Organization
Contact information
Practice address
2900 LAKEVIEW AVE, SAINT JOSEPH, MI 49085-2379
(269) 408-4322
(269) 408-4340
Mailing address
2900 LAKEVIEW AVE, SAINT JOSEPH, MI 49085-2379
(269) 408-4322
(269) 408-4340
Taxonomy
Speciality
Code
Description
License number
State
251T00000X
PACE Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2331543
—
MI
01
—
2332863
MEDICAID BILLING AGENT ID
MI
Enumeration date
01/14/2013
Last updated
05/14/2013
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