MEDICARE: ADVISACARE SOLUTIONS OF ARIZONA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1114449956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVISACARE SOLUTIONS OF ARIZONA, LLC

Provider Business Mailing Address
First Line	:	4234 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-8384
Country	:	US
Telephone Number	:	616-464-1117
Fax Number	:	616-464-1044

Provider Business Practice Location Address
First Line	:	698 E WETMORE RD STE 330
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85705-1752
Country	:	US
Telephone Number	:	520-323-2559
Fax Number	:	520-323-2561

Authorized Official
Title or Position	:	CEO
Name	:	KRISTIAN SKOGEN
Credential	:
Telephone Number	:	616-464-1117

Provider Enumeration Date	:	07/13/2017
Last Update Date	:	07/13/2017

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