Healthcare Provider Details

I. General information

NPI: 1447542246
Provider Name (Legal Business Name): ADVANCED NURSING CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 SURREY WAY
EXTON PA
19341-1672
US

IV. Provider business mailing address

63 SURREY WAY
EXTON PA
19341-1672
US

V. Phone/Fax

Practice location:
  • Phone: 302-897-4072
  • Fax:
Mailing address:
  • Phone: 302-897-4072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number20663601
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number20663601
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier20663601
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA DEPT OH HEALTH

VIII. Authorized Official

Name: MR. JOHN KUNGU
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 302-897-4072