1609973577 NPI number — ACES INC.

Table of content: (NPI 1609973577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609973577 NPI number — ACES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PIONEER HEATH RESOURCES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609973577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/09/2011
NPI Reactivation Date:
10/31/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5583 N GLENWOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN CITY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83714-1336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-287-2564
Provider Business Mailing Address Fax Number:
208-287-2570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 N COLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-8638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-322-1026
Provider Business Practice Location Address Fax Number:
208-322-1029
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GROSS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
208-619-0190

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 807386100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806388100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807379000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807405600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806383200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807378900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807473200 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807405500 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 907379100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 806431100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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