Provider Demographics
NPI:1114449956
Name:ADVISACARE SOLUTIONS OF ARIZONA, LLC
Entity Type:Organization
Organization Name:ADVISACARE SOLUTIONS OF ARIZONA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-464-1117
Mailing Address - Street 1:4234 CASCADE RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-8384
Mailing Address - Country:US
Mailing Address - Phone:616-464-1117
Mailing Address - Fax:616-464-1044
Practice Address - Street 1:698 E WETMORE RD STE 330
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1752
Practice Address - Country:US
Practice Address - Phone:520-323-2559
Practice Address - Fax:520-323-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health