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General NPI Number Information
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NPI Number | 1003007105
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Entity Type | Organization
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Legal Business Name | ADVISACARE HEALTHCARE SOLUTIONS, INC.
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 3600 PORT OF TACOMA RD STE 511
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City | FIFE
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State | WA
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Zip | 98424-1044
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Country | US
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Telephone | 253-922-5501
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Fax | 253-922-5308
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Provider Business Mailing Address
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Address Line | 4234 CASCADE RD SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8384
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Country | US
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Telephone | 616-464-1117
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Fax | 616-464-1044
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Authorized Official
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Title or Position | PRESIDENT
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Name | LISE' SKOGEN
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Credential |
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Telephone | 616-464-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 602586915
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License Number State | WA
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