Provider Demographics
NPI:1437116563
Name:ADVANCE HEALTH CARE SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCE HEALTH CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LENICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-870-3521
Mailing Address - Street 1:111 E DUNLAP AVE
Mailing Address - Street 2:SUITE 1-125
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2807
Mailing Address - Country:US
Mailing Address - Phone:602-870-3521
Mailing Address - Fax:602-926-8393
Practice Address - Street 1:111 E DUNLAP AVE
Practice Address - Street 2:SUITE 1-125
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2807
Practice Address - Country:US
Practice Address - Phone:602-870-3521
Practice Address - Fax:602-926-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03008202332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9058934Medicaid
AZ944688Medicaid
CAXDME03012Medicaid
AZ4868840001Medicare NSC