Healthcare Provider Details

I. General information

NPI: 1316793722
Provider Name (Legal Business Name): ADVANTAGE CARE #0001 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W EUCLID AVE
PHOENIX AZ
85041-8345
US

IV. Provider business mailing address

668 N COAST HWY STE 516
LAGUNA BEACH CA
92651-1513
US

V. Phone/Fax

Practice location:
  • Phone: 714-272-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: VALENA JORDAN
Title or Position: BUSINESS DEVELOPMENT SPECIALIST
Credential:
Phone: 602-782-0216