Provider Demographics
NPI:1023110236
Name:ACE HOME MEDICAL LLC
Entity type:Organization
Organization Name:ACE HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:CELESTINE
Authorized Official - Last Name:OMALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-745-5751
Mailing Address - Street 1:4807 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3548
Mailing Address - Country:US
Mailing Address - Phone:334-756-8790
Mailing Address - Fax:334-756-8792
Practice Address - Street 1:2214 GATEWAY DR
Practice Address - Street 2:SUITE G
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-1500
Practice Address - Country:US
Practice Address - Phone:334-745-5751
Practice Address - Fax:334-745-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL672332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533440OtherALABAMA BCBS
AL5614330001Medicare ID - Type UnspecifiedMEDICARE NUMBER