MEDICARE: ADVANCE SPECIALTY CARE NORTH, INC.

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	:	1528440351
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE SPECIALTY CARE NORTH, INC.

Provider Business Mailing Address
First Line	:	6260 LAUREL CANYON BLVD STE 304
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3234
Country	:	US
Telephone Number	:	818-308-3841
Fax Number	:	818-308-3846

Provider Business Practice Location Address
First Line	:	6260 LAUREL CANYON BLVD STE 304
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-3234
Country	:	US
Telephone Number	:	818-308-3841
Fax Number	:	818-308-3846

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JOAN CAMACHO
Credential	:
Telephone Number	:	951-321-0938

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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