Provider Demographics
NPI:1649440728
Name:ADVANCED CARE AGENCY INC.
Entity type:Organization
Organization Name:ADVANCED CARE AGENCY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SWINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-478-0399
Mailing Address - Street 1:212 SHANGRI LA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32132
Mailing Address - Country:US
Mailing Address - Phone:386-478-0399
Mailing Address - Fax:386-427-6425
Practice Address - Street 1:212 SHANGRI LA CIRCLE
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32132
Practice Address - Country:US
Practice Address - Phone:386-478-0399
Practice Address - Fax:386-427-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA51755376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
692282196OtherMEDWAIVER PROGRAM STATE