Provider Demographics
NPI:1780746735
Name:ACV COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:ACV COMMUNITY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-658-5500
Mailing Address - Street 1:PO BOX 4675
Mailing Address - Street 2:
Mailing Address - City:DOWLING PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-1507
Mailing Address - Country:US
Mailing Address - Phone:386-658-5450
Mailing Address - Fax:386-658-5111
Practice Address - Street 1:23740 PARK CENTER DR.
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-658-5460
Practice Address - Fax:386-658-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19963313251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6507573000Medicaid
FL6507573000Medicaid