MEDICARE: ADVANCE HEALTH CARE SYSTEM, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	225700000X	Massage Therapist	AZ
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	AZ
3	251E00000X	Home Health Agency	AZ

General Provider Information

NPI Number	:	1295090793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE HEALTH CARE SYSTEM, LLC

Provider Business Mailing Address
First Line	:	4267 FOXPOINT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323
Country	:	US
Telephone Number	:	248-302-5493
Fax Number	:

Provider Business Practice Location Address
First Line	:	4267 FOXPOINT
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323
Country	:	US
Telephone Number	:	248-302-5493
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ANGELA PATTERSON
Credential	:
Telephone Number	:	248-302-5493

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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Directions to “ADVANCE HEALTH CARE SYSTEM, LLC ” Practice Location

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