MEDICARE: ACE HOME SERVICES GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	4704271175	MI

General Provider Information

NPI Number	:	1043569817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE HOME SERVICES GROUP LLC

Provider Business Mailing Address
First Line	:	3948 FARNUM ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2763
Country	:	US
Telephone Number	:	734-895-3630
Fax Number	:

Provider Business Practice Location Address
First Line	:	3948 FARNUM ST
Second Line	:
City	:	INKSTER
State	:	MI
Zip	:	48141-2763
Country	:	US
Telephone Number	:	734-895-3630
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AMELIA M MCDONALD
Credential	:
Telephone Number	:	734-895-3630

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	10/03/2012

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