MEDICARE: ADVANCED CARE HEALTH SOLUTIONS, 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	261QD1600X	Developmental Disabilities Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568978617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED CARE HEALTH SOLUTIONS, LLC.

Provider Business Mailing Address
First Line	:	9225 PROSPERITY LAKE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-8446
Country	:	US
Telephone Number	:	252-813-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	9225 PROSPERITY LAKE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-8446
Country	:	US
Telephone Number	:	252-813-2409
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOLANDA BASCOME
Credential	:
Telephone Number	:	252-813-2409

Provider Enumeration Date	:	12/26/2017
Last Update Date	:	06/16/2018

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