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General NPI Number Information
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NPI Number | 1093223000
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Entity Type | Organization
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Legal Business Name | ADVANCED SENIOR CARE, LLC
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 3336 BRADSHAW RD STE 275
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City | SACRAMENTO
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State | CA
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Zip | 95827-2620
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Country | US
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Telephone | 916-671-5777
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Fax | 916-228-4694
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Provider Business Mailing Address
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Address Line | 3336 BRADSHAW RD STE 275
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City | SACRAMENTO
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State | CA
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Zip | 95827-2620
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Country | US
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Telephone | 916-671-5777
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Fax | 916-228-4694
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Authorized Official
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Title or Position | CEO/OWNER
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Name | TERRY WATTS
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Credential | MBA
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Telephone | 916-671-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 344700053
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License Number State | CA
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