Provider Demographics
NPI:1669627170
Name:ADVANCED CLINICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED CLINICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:IZDEBSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:602-373-0540
Mailing Address - Street 1:10752 N 89TH PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6730
Mailing Address - Country:US
Mailing Address - Phone:602-373-0540
Mailing Address - Fax:480-477-6571
Practice Address - Street 1:10752 N 89TH PL
Practice Address - Street 2:SUITE 203
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6730
Practice Address - Country:US
Practice Address - Phone:602-373-0540
Practice Address - Fax:480-477-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHHA4479251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health