MEDICARE: CONTINENCE CENTER OF AMERICA 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1700809787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONTINENCE CENTER OF AMERICA INC

Provider Business Mailing Address
First Line	:	PO BOX 54459
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85078-4459
Country	:	US
Telephone Number	:	623-977-1212
Fax Number	:	623-875-1815

Provider Business Practice Location Address
First Line	:	13000 N 103RD AVE STE 73
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-3056
Country	:	US
Telephone Number	:	623-977-1212
Fax Number	:	623-875-1815

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOEL J ROSEN
Credential	:
Telephone Number	:	623-977-1212

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	03/29/2019

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