Provider Demographics
NPI:1790256535
Name:GWEN'S ADVANCE CARE
Entity Type:Organization
Organization Name:GWEN'S ADVANCE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:JOLINE
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:602-595-5707
Mailing Address - Street 1:1635 E BASELINE RD STE 109
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6891
Mailing Address - Country:US
Mailing Address - Phone:602-595-5707
Mailing Address - Fax:602-595-7147
Practice Address - Street 1:1635 E BASELINE RD STE 109
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6891
Practice Address - Country:US
Practice Address - Phone:602-595-5707
Practice Address - Fax:602-595-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health