Provider Demographics
NPI:1326117250
Name:DOUBLE ACE HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:DOUBLE ACE HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MIYAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-476-9922
Mailing Address - Street 1:8459 WHITE OAK AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3872
Mailing Address - Country:US
Mailing Address - Phone:909-476-9922
Mailing Address - Fax:909-476-0033
Practice Address - Street 1:8459 WHITE OAK AVE
Practice Address - Street 2:#104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3872
Practice Address - Country:US
Practice Address - Phone:909-476-9922
Practice Address - Fax:909-476-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000879251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA058328Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER