=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437546082
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CARE HOME HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2015
-----------------------------------------------------
Last Update Date | 01/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9126 SW RIDDER RD
-----------------------------------------------------
City | WILSONVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97070-6766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-254-9344
-----------------------------------------------------
Fax | 971-254-9345
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9126 SW RIDDER RD
-----------------------------------------------------
City | WILSONVILLE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97070-6766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-254-9344
-----------------------------------------------------
Fax | 971-254-9345
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | KYLE DUSTIN NIELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 503-308-4060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------