MEDICARE: ADELANTE HEALTHCARE, 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1770991291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADELANTE HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	3033 N CENTRAL AVE STE 145
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2808
Country	:	US
Telephone Number	:	877-809-5092
Fax Number	:	623-876-9559

Provider Business Practice Location Address
First Line	:	15525 N 83RD AVE STE 104
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85382-5820
Country	:	US
Telephone Number	:	480-964-2273
Fax Number	:	623-505-3272

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	KRYSTAL POWELL
Credential	:
Telephone Number	:	623-583-3001

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	04/28/2023

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