Healthcare Provider Details

I. General information

NPI: 1083033369
Provider Name (Legal Business Name): ADULT HEALTHCARE ADVOCACY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 PROFESSIONAL CENTER DR SUITE A
ROHNERT PARK CA
94928-2144
US

IV. Provider business mailing address

170 PROFESSIONAL CENTER DR SUITE A
ROHNERT PARK CA
94928-2144
US

V. Phone/Fax

Practice location:
  • Phone: 707-595-5258
  • Fax: 707-595-5276
Mailing address:
  • Phone: 707-595-5258
  • Fax: 707-595-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ERIC CONSTANTINE
Title or Position: CEO
Credential:
Phone: 707-595-5258