MEDICARE: ADVANCE CARE SERVICES FTW 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	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1649949892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CARE SERVICES FTW LLC

Provider Business Mailing Address
First Line	:	8196 COMMUNITY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2048
Country	:	US
Telephone Number	:	260-467-9649
Fax Number	:

Provider Business Practice Location Address
First Line	:	8196 COMMUNITY LN
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-2048
Country	:	US
Telephone Number	:	260-467-9649
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS SHAVON LOFTON
Credential	:
Telephone Number	:	260-467-9649

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	09/10/2021

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