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General NPI Number Information
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NPI Number | 1730365628
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Entity Type | Organization
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Legal Business Name | ADVANCED COMPREHENSIVE ELDERLY CARE SERVICES, INC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 09/07/2008
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Provider Practice Location Address
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Address Line | 4102 W LINEBAUGH AVE
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City | TAMPA
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State | FL
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Zip | 33624-5296
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Country | US
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Telephone | 813-389-9563
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Fax | 352-588-3699
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Provider Business Mailing Address
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Address Line | PO BOX 845
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City | SAN ANTONIO
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State | FL
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Zip | 33576-0845
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Country | US
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Telephone | 813-389-9563
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Fax | 352-588-3699
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CAROL A ROTH
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Credential | LCSW
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Telephone | 813-389-9563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW 3024
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License Number State | FL
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