Provider Demographics
NPI:1407094311
Name:FIRST ADVANCED CARE INC DBA ADVANCED CARE AMBULETTE
Entity Type:Organization
Organization Name:FIRST ADVANCED CARE INC DBA ADVANCED CARE AMBULETTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/BILLING DEPARTMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIMI
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:TRANSPORTATION
Authorized Official - Phone:718-743-2100
Mailing Address - Street 1:1411 GRAVESEND NECK RD
Mailing Address - Street 2:#1FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-743-2100
Mailing Address - Fax:718-743-4344
Practice Address - Street 1:1411 GRAVESEND NECK RD
Practice Address - Street 2:#1FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-743-2100
Practice Address - Fax:718-743-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03059616Medicaid