=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427073493
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACE HOMECARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 04/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3656 INNOVATION DR
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33812-4105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-644-1968
-----------------------------------------------------
Fax | 863-644-7950
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2261
-----------------------------------------------------
City | MANGO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33550-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-621-0020
-----------------------------------------------------
Fax | 813-621-0022
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CIO
-----------------------------------------------------
Name | ARTHUR S BARLAAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-621-0020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299992170
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------