Provider Demographics
NPI:1255202255
Name:PACE HEALING CENTER
Entity type:Organization
Organization Name:PACE HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FATMATA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:124-042-2476
Mailing Address - Street 1:11706 WYNNIFRED PL
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11706 WYNNIFRED PL
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9482
Practice Address - Country:US
Practice Address - Phone:240-422-4768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty