MEDICARE: ACE TECH CHARTER HS

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1386070589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE TECH CHARTER HS

Provider Business Mailing Address
First Line	:	5410 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-6342
Country	:	US
Telephone Number	:	773-548-8705
Fax Number	:

Provider Business Practice Location Address
First Line	:	5410 S STATE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-6342
Country	:	US
Telephone Number	:	773-548-8705
Fax Number	:

Authorized Official
Title or Position	:	DATA AND TESTING COORDINATOR
Name	:	MR. EDWARD PALMISANO
Credential	:	M.ED.
Telephone Number	:	773-548-8705

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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