Provider Demographics
NPI:1275521247
Name:ADVANCED VITAL CARE, INC
Entity Type:Organization
Organization Name:ADVANCED VITAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-262-5500
Mailing Address - Street 1:4020 W ALI BABA LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1670
Mailing Address - Country:US
Mailing Address - Phone:702-262-5500
Mailing Address - Fax:702-262-9997
Practice Address - Street 1:4020 W ALI BABA LN
Practice Address - Street 2:SUITE D
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1670
Practice Address - Country:US
Practice Address - Phone:702-262-5500
Practice Address - Fax:702-262-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3731HHA-3251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicare ID - Type UnspecifiedMEDICARE ID