MEDICARE: ADVANCED HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	IS-206	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0095104	OTHER	WA	DEPT. OF LABOR/INDUSTRIES

General Provider Information

NPI Number	:	1033104575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	9116 GRAVELLY LAKE DR SW
Second Line	:	SUITE B1
City	:	TACOMA
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-475-7744
Fax Number	:	253-471-1552

Provider Business Practice Location Address
First Line	:	9116 GRAVELLY LAKE DR SW
Second Line	:	SUITE B1
City	:	TACOMA
State	:	WA
Zip	:	98499-3148
Country	:	US
Telephone Number	:	253-475-7744
Fax Number	:	253-471-1552

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD G. BODE
Credential	:
Telephone Number	:	253-475-7744

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	10/20/2007

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