Provider Demographics
NPI:1427558345
Name:ADVANCED HEALTHCARE LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAYRA
Authorized Official - Middle Name:ERENDIRA
Authorized Official - Last Name:GAONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-503-0481
Mailing Address - Street 1:101 LIVINGSTON LOOP STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9753
Mailing Address - Country:US
Mailing Address - Phone:915-503-0481
Mailing Address - Fax:
Practice Address - Street 1:101 LIVINGSTON LOOP STE 5
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9753
Practice Address - Country:US
Practice Address - Phone:915-503-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health