1033104575 NPI number — ADVANCED HEALTH CARE, INC.

Table of content: (NPI 1033104575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033104575 NPI number — ADVANCED HEALTH CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HEALTH CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033104575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9116 GRAVELLY LAKE DR SW
Provider Second Line Business Mailing Address:
SUITE B1
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-3148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-475-7744
Provider Business Mailing Address Fax Number:
253-471-1552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9116 GRAVELLY LAKE DR SW
Provider Second Line Business Practice Location Address:
SUITE B1
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98499-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-475-7744
Provider Business Practice Location Address Fax Number:
253-471-1552
Provider Enumeration Date:
09/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BODE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-475-7744

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  IS-206 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0095104 . This is a "DEPT. OF LABOR/INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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