Provider Demographics
NPI:1568232239
Name:ACE HOLISTIC SUPPORT INC
Entity Type:Organization
Organization Name:ACE HOLISTIC SUPPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EPHRAIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAKINDE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:240-421-1251
Mailing Address - Street 1:11720 BELTSVILLE DR STE 500-A5
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3166
Mailing Address - Country:US
Mailing Address - Phone:667-392-3765
Mailing Address - Fax:240-540-6170
Practice Address - Street 1:11720 BELTSVILLE DR STE 500-A5
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3166
Practice Address - Country:US
Practice Address - Phone:667-392-3765
Practice Address - Fax:240-540-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services