MEDICARE: ACADIA, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1831503671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADIA, LLC

Provider Business Mailing Address
First Line	:	387 LAKE HAVASU AVE S STE 102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	387 LAKE HAVASU AVE S STE 102
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-9306
Country	:	US
Telephone Number	:	301-639-3822
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	CHRISTOPHER L GAMBLE
Credential	:
Telephone Number	:	301-639-3822

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	06/19/2014

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