Provider Demographics
NPI:1710769682
Name:ADVANTA SENIOR CARE, INC
Entity Type:Organization
Organization Name:ADVANTA SENIOR CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCKEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-304-8328
Mailing Address - Street 1:41593 WINCHESTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4857
Mailing Address - Country:US
Mailing Address - Phone:951-252-6111
Mailing Address - Fax:951-972-8944
Practice Address - Street 1:41593 WINCHESTER RD STE 200
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4857
Practice Address - Country:US
Practice Address - Phone:951-252-6111
Practice Address - Fax:951-972-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care