1790354876 NPI number — ACE CARE HEALTHCARE SERVICES INC

Table of content: (NPI 1790354876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790354876 NPI number — ACE CARE HEALTHCARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACE CARE HEALTHCARE SERVICES 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:
Provider Other Organization Name Type Code:
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:
1790354876
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 E INTERSTATE 30 STE M106B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75043-4022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-373-4039
Provider Business Mailing Address Fax Number:
214-643-6815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 E INTERSTATE 30 STE M106B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75043-4022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-325-1385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KERICH
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-373-4039

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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