Provider Demographics
NPI:1518196831
Name:ACE HOME CARE SERVICES, INC.
Entity Type:Organization
Organization Name:ACE HOME CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOBIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:IBANITORU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-956-2688
Mailing Address - Street 1:500 NORTH GROTTO STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-222-0558
Mailing Address - Fax:651-222-6869
Practice Address - Street 1:500 NORTH GROTTO STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-222-0558
Practice Address - Fax:651-222-6869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163W00000X, 163WC0400X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNM883417000Medicaid