Provider Demographics
NPI:1417332057
Name:ADVANCE SPECIALTY CARE SOUTH, INC.
Entity Type:Organization
Organization Name:ADVANCE SPECIALTY CARE SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMBULAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-310-3338
Mailing Address - Street 1:12437 LEWIST ST
Mailing Address - Street 2:201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5817
Mailing Address - Country:US
Mailing Address - Phone:714-276-1115
Mailing Address - Fax:714-276-1112
Practice Address - Street 1:12437 LEWIST STREET
Practice Address - Street 2:201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5817
Practice Address - Country:US
Practice Address - Phone:714-276-1115
Practice Address - Fax:714-276-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health