Provider Demographics
NPI:1265284970
Name:ADVANCED CARE LIFE CENTERS
Entity type:Organization
Organization Name:ADVANCED CARE LIFE CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-262-2252
Mailing Address - Street 1:1463 E. MCANDREWS RD
Mailing Address - Street 2:#A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-262-2252
Mailing Address - Fax:541-787-6382
Practice Address - Street 1:1463 E. MCANDREWS RD
Practice Address - Street 2:#A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-262-2252
Practice Address - Fax:541-787-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-04
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care