Provider Demographics
NPI:1104319813
Name:ADVANCE HEALTHCARE
Entity type:Organization
Organization Name:ADVANCE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:714-856-4341
Mailing Address - Street 1:4961 ARROW HWY UNIT 104
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-1302
Mailing Address - Country:US
Mailing Address - Phone:714-856-4341
Mailing Address - Fax:
Practice Address - Street 1:1007 E COOLEY DR # 119
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3901
Practice Address - Country:US
Practice Address - Phone:714-856-4341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies