Provider Demographics
NPI:1740344563
Name:ACV COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:ACV COMMUNITY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-658-5500
Mailing Address - Street 1:PO BOX 4675
Mailing Address - Street 2:
Mailing Address - City:DOWLING PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-1507
Mailing Address - Country:US
Mailing Address - Phone:386-658-5450
Mailing Address - Fax:386-658-5111
Practice Address - Street 1:10676 MARVIN E. JONES BLVD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060
Practice Address - Country:US
Practice Address - Phone:386-658-5552
Practice Address - Fax:386-658-5535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11911091310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650757301Medicaid
FL141244200Medicaid