Provider Demographics
NPI:1669649349
Name:AC HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:AC HOME HEALTH CARE LLC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-590-9510
Mailing Address - Street 1:5737 CONSTITUTION AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADOSPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915
Mailing Address - Country:US
Mailing Address - Phone:719-590-9510
Mailing Address - Fax:719-535-9212
Practice Address - Street 1:5737 CONSTITUTION AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-1220
Practice Address - Country:US
Practice Address - Phone:719-590-9510
Practice Address - Fax:719-535-9212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-13
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92931235251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health