Provider Demographics
NPI:1699025551
Name:ACE HOMECARE LLC
Entity Type:Organization
Organization Name:ACE HOMECARE LLC
Other - Org Name:ACE HOMECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS COMPLIANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLANA BURKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-621-0020
Mailing Address - Street 1:PO BOX 2261
Mailing Address - Street 2:
Mailing Address - City:MANGO
Mailing Address - State:FL
Mailing Address - Zip Code:33550-2261
Mailing Address - Country:US
Mailing Address - Phone:813-621-0020
Mailing Address - Fax:
Practice Address - Street 1:4051 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3551
Practice Address - Country:US
Practice Address - Phone:352-563-0663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACE HOMECARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL212040961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650303900Medicaid
FL107583Medicare Oscar/Certification