Healthcare Provider Details

I. General information

NPI: 1326327891
Provider Name (Legal Business Name): ACES CARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S 6TH ST
HANNIBAL MO
63401-4319
US

IV. Provider business mailing address

PO BOX 1536
HANNIBAL MO
63401-1536
US

V. Phone/Fax

Practice location:
  • Phone: 573-221-3356
  • Fax:
Mailing address:
  • Phone: 573-221-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRAD WESLEY WALDEN
Title or Position: PRESIDENT
Credential:
Phone: 573-221-3356