Provider Demographics
NPI:1245901529
Name:ACE 1 LLC
Entity type:Organization
Organization Name:ACE 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER- MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNIE JUNE
Authorized Official - Middle Name:PASCUA
Authorized Official - Last Name:CULLINAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-731-5520
Mailing Address - Street 1:101 AUPUNI ST STE 225
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4261
Mailing Address - Country:US
Mailing Address - Phone:808-731-5520
Mailing Address - Fax:808-731-5521
Practice Address - Street 1:77-6480 SEA VIEW CIR
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-8945
Practice Address - Country:US
Practice Address - Phone:808-339-0964
Practice Address - Fax:808-731-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-25
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000022Medicaid