Provider Demographics
NPI:1033104575
Name:ADVANCED HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ADVANCED HEALTH CARE, INC.
Other - Org Name:ADVANCED HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-475-7744
Mailing Address - Street 1:9116 GRAVELLY LAKE DR SW
Mailing Address - Street 2:SUITE B1
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3148
Mailing Address - Country:US
Mailing Address - Phone:253-475-7744
Mailing Address - Fax:253-471-1552
Practice Address - Street 1:9116 GRAVELLY LAKE DR SW
Practice Address - Street 2:SUITE B1
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98499-3148
Practice Address - Country:US
Practice Address - Phone:253-475-7744
Practice Address - Fax:253-471-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS-206251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0095104OtherDEPT. OF LABOR/INDUSTRIES