Provider Demographics
NPI:1477309516
Name:ACE'S DOGGONE FAVS
Entity type:Organization
Organization Name:ACE'S DOGGONE FAVS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUWANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-249-9720
Mailing Address - Street 1:8850 MEADOWMONT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-6191
Mailing Address - Country:US
Mailing Address - Phone:704-249-9720
Mailing Address - Fax:
Practice Address - Street 1:615 E 6TH ST STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2918
Practice Address - Country:US
Practice Address - Phone:704-249-9720
Practice Address - Fax:855-345-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty