Provider Demographics
NPI:1396447330
Name:BACE INSTITUTE, LLC
Entity type:Organization
Organization Name:BACE INSTITUTE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CAYABYAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-255-2634
Mailing Address - Street 1:14125 TELEPHONE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5771
Mailing Address - Country:US
Mailing Address - Phone:657-255-2634
Mailing Address - Fax:657-255-2633
Practice Address - Street 1:14125 TELEPHONE AVE STE 11
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5771
Practice Address - Country:US
Practice Address - Phone:657-255-2634
Practice Address - Fax:657-255-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies