Provider Demographics
NPI:1548476617
Name:ACE HOME MEDICAL, LLC
Entity type:Organization
Organization Name:ACE HOME MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERELY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-8790
Mailing Address - Street 1:4807 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3548
Mailing Address - Country:US
Mailing Address - Phone:334-756-8790
Mailing Address - Fax:334-756-8792
Practice Address - Street 1:4807 20TH AVE
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3548
Practice Address - Country:US
Practice Address - Phone:334-756-8790
Practice Address - Fax:334-756-8792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533440OtherBCBS OF ALABAMA
AL51533440OtherBCBS OF ALABAMA