Provider Demographics
NPI:1154027811
Name:ACE OF HEARTS MEDICAL TRANSPORTATION, LLC.
Entity type:Organization
Organization Name:ACE OF HEARTS MEDICAL TRANSPORTATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDRE
Authorized Official - Middle Name:SASHA
Authorized Official - Last Name:KALUZHSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-213-5063
Mailing Address - Street 1:7693 PALMILLA DR APT 2416
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5088
Mailing Address - Country:US
Mailing Address - Phone:858-213-5063
Mailing Address - Fax:
Practice Address - Street 1:7693 PALMILLA DR APT 2416
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-5088
Practice Address - Country:US
Practice Address - Phone:858-213-5063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)