MEDICARE: ADVANCE CARE CORP

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

General Provider Information

NPI Number	:	1093190399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE CARE CORP

Provider Business Mailing Address
First Line	:	3321 W CYPRESS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3321 W CYPRESS ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5005
Country	:	US
Telephone Number	:	813-599-1994
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DENISE HAUQUE
Credential	:
Telephone Number	:	813-735-7762

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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