Provider Demographics
NPI:1699320580
Name:ACECARE MEDICAL HOUSECALLS
Entity type:Organization
Organization Name:ACECARE MEDICAL HOUSECALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ENOBONG
Authorized Official - Middle Name:C
Authorized Official - Last Name:UDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-271-2954
Mailing Address - Street 1:101 E PARK BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8818
Mailing Address - Country:US
Mailing Address - Phone:507-271-2954
Mailing Address - Fax:
Practice Address - Street 1:101 E PARK BLVD STE 600
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-8818
Practice Address - Country:US
Practice Address - Phone:507-271-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service