Provider Demographics
NPI: | 1518188507 |
---|---|
Name: | ACES |
Entity Type: | Organization |
Organization Name: | ACES |
Other - Org Name: | PIONEER HEALTH RESOURCES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DONALD |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GROSS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 208-322-1026 |
Mailing Address - Street 1: | 890 N. COLE RD. |
Mailing Address - Street 2: | |
Mailing Address - City: | BOISE |
Mailing Address - State: | ID |
Mailing Address - Zip Code: | 83704 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 208-322-1026 |
Mailing Address - Fax: | 208-322-1029 |
Practice Address - Street 1: | 890 N. COLE RD. |
Practice Address - Street 2: | |
Practice Address - City: | BOISE |
Practice Address - State: | ID |
Practice Address - Zip Code: | 83704 |
Practice Address - Country: | US |
Practice Address - Phone: | 208-322-1026 |
Practice Address - Fax: | 208-322-1029 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-01 |
Last Update Date: | 2011-12-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
ID | 1609973577 | Medicaid | |
ID | 807639800 | Other | BOISE-SC |
ID | 1760601751 | Medicaid |