Provider Demographics
NPI:1922376359
Name:ACE NURSES/AIDES REGISTRY LLC
Entity Type:Organization
Organization Name:ACE NURSES/AIDES REGISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIUS
Authorized Official - Middle Name:OTHELLO
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-728-9252
Mailing Address - Street 1:25 MISSION POINTE LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6660
Mailing Address - Country:US
Mailing Address - Phone:770-728-9252
Mailing Address - Fax:678-609-1631
Practice Address - Street 1:355 TALL OAKS DR SE UNIT 205
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1616
Practice Address - Country:US
Practice Address - Phone:770-728-9252
Practice Address - Fax:678-609-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA107-R-1014251G00000X, 251J00000X, 253Z00000X, 311Z00000X, 385H00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251G00000XAgenciesHospice Care, Community Based
No251J00000XAgenciesNursing Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146883AMedicaid