Provider Demographics
NPI:1497009351
Name:ADVANCED COMMUNITY CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED COMMUNITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONNIE
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-358-3344
Mailing Address - Street 1:3225 WYNDHAM PARK LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-5465
Mailing Address - Country:US
Mailing Address - Phone:919-358-3344
Mailing Address - Fax:
Practice Address - Street 1:3225 WYNDHAM PARK LN
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5465
Practice Address - Country:US
Practice Address - Phone:919-358-3344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health