Provider Demographics
NPI:1497143747
Name:ADVANCED CARE NORTHWEST LLC
Entity Type:Organization
Organization Name:ADVANCED CARE NORTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-263-3225
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:BONNERS FERRY
Mailing Address - State:ID
Mailing Address - Zip Code:83805-1869
Mailing Address - Country:US
Mailing Address - Phone:208-263-3225
Mailing Address - Fax:208-267-2003
Practice Address - Street 1:1009 HIGHWAY 2
Practice Address - Street 2:SUITE E
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2712
Practice Address - Country:US
Practice Address - Phone:208-263-3225
Practice Address - Fax:208-267-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA0001748Medicaid