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NPI Code Detail

MEDICARE: ACE PCA SERVICE INC

MEDICARE: ACE PCA SERVICE INC
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
1251E00000XHome Health Agency552446600MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2388M3ACOTHERMNBLUE PLUS

General Provider Information

NPI Number : 1861574071
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACE PCA SERVICE INC
Provider Business Mailing Address
First Line : 2019 E LAKE ST
Second Line : 7
City : MINNEAPOLIS
State : MN
Zip : 55407-1925
Country : US
Telephone Number : 612-721-9900
Fax Number : 612-721-9905
Provider Business Practice Location Address
First Line : 2019 E LAKE ST
Second Line : 7
City : MINNEAPOLIS
State : MN
Zip : 55407-1925
Country : US
Telephone Number : 612-721-9900
Fax Number : 612-721-9905
Authorized Official
Title or Position : DIRECTOR
Name : AHMED ROBLE
Credential :
Telephone Number : 612-721-9900
Provider Enumeration Date : 10/19/2006
Last Update Date : 06/16/2008

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