Healthcare Provider Details

I. General information

NPI: 1881217248
Provider Name (Legal Business Name): ADELANTE HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13471 W CORNERSTONE BLVD
GOODYEAR AZ
85395-2713
US

IV. Provider business mailing address

3033 N CENTRAL AVE
PHOENIX AZ
85012-2809
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-2273
  • Fax:
Mailing address:
  • Phone: 623-583-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL POWELL
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 623-583-3001