Provider Demographics
NPI:1003849605
Name:ACE FOSTER CARE AND PEDIATRIC HOME NURSING AGENCY
Entity Type:Organization
Organization Name:ACE FOSTER CARE AND PEDIATRIC HOME NURSING AGENCY
Other - Org Name:ACE PEDIATRIC HOME NURSING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-989-9650
Mailing Address - Street 1:7026 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2208
Mailing Address - Country:US
Mailing Address - Phone:219-989-9650
Mailing Address - Fax:219-989-9649
Practice Address - Street 1:7026 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2208
Practice Address - Country:US
Practice Address - Phone:219-989-9650
Practice Address - Fax:219-989-9649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060043871251E00000X
IN81686098 53728253J00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200498280AMedicaid
IN200498280AMedicaid