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General NPI Number Information
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NPI Number | 1417332057
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Entity Type | Organization
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Legal Business Name | ADVANCE SPECIALTY CARE SOUTH, INC.
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 12437 LEWIST STREET 201
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5817
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Country | US
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Telephone | 714-276-1115
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Fax | 714-276-1112
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Provider Business Mailing Address
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Address Line | 12437 LEWIST ST 201
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City | GARDEN GROVE
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State | CA
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Zip | 92840-5817
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Country | US
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Telephone | 714-276-1115
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Fax | 714-276-1112
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN P SIMBULAN
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Credential |
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Telephone | 951-310-3338
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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 |
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License Number State |
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