Healthcare Provider Details

I. General information

NPI: 1851455901
Provider Name (Legal Business Name): AVANTE CARE ANCILLARY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HOLLYWOOD BLVD SUITE 540 NORTH
HOLLYWOOD FL
33021-6751
US

IV. Provider business mailing address

4000 HOLLYWOOD BLVD SUITE 540 NORTH
HOLLYWOOD FL
33021-6751
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-7180
  • Fax: 954-989-5287
Mailing address:
  • Phone: 954-987-7180
  • Fax: 954-989-5287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DEAN J DICKMANN
Title or Position: PRESIDENT
Credential:
Phone: 954-987-7180