Provider Demographics
NPI:1245568930
Name:ACE-AGENCY FOR COMMUNITY EMPOWERMENT , INC.
Entity Type:Organization
Organization Name:ACE-AGENCY FOR COMMUNITY EMPOWERMENT , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/TREASURER OF BOD
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SHEPHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-551-0760
Mailing Address - Street 1:5730 BOWDEN RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6104
Mailing Address - Country:US
Mailing Address - Phone:904-551-0760
Mailing Address - Fax:
Practice Address - Street 1:5730 BOWDEN RD
Practice Address - Street 2:SUITE 206
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6104
Practice Address - Country:US
Practice Address - Phone:904-551-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000985801Medicaid
FL000985800Medicaid
FL002066400Medicaid