West Baltimore Pace Community Coalition, LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

WEST BALTIMORE PACE COMMUNITY COALITION, LLC

Practice address

3201A Tioga Pkwy Ste a
Baltimore, MD 21215-7987

Phone

(443) 961-0796

Fax

(443) 961-0797

NPI assigned

Jan 24, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Billingsley

Title

Chief Administration Officer

Phone

(617) 594-7753

Specialties & licenses 1

Addresses

Other names 1

• Edenbridge PACE of West Baltimore Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1023870284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201A TIOGA PKWY STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212157987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201A TIOGA PKWY STE A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212157987",
            "telephone_number": "443-961-0796",
            "fax_number": "443-961-0797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BALTIMORE PACE COMMUNITY COALITION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "BILLINGSLEY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATION OFFICER",
        "authorized_official_telephone_number": "617-594-7753"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edenbridge PACE of West Baltimore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Ann Wessels, PHYSICAL THERAPIST
• Hadley Katharine Wesson, MD
• Russell Noel Wesson, M.B.CH.B
• Tristan Hunter Wesson
• West Baltimore Emergency Medicine Physicians, LLC
• West House Sober Living Home
• West North Pharmacy, Inc
• West Wellness Group
• Irene V. West-Dixon, LGSW
• Almaz Getachew West, LCPC, CRC. PHD

• PACE Provider Organization in Baltimore, MD
• Providers in Baltimore, MD by specialty
• PACE Provider Organization in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.