Provider Demographics
NPI:1528099744
Name:ADVANCED HEALTH CARE CORPORATION
Entity type:Organization
Organization Name:ADVANCED HEALTH CARE CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:NATTRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9860
Mailing Address - Street 1:140 N UNION AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2961
Mailing Address - Country:US
Mailing Address - Phone:208-739-1461
Mailing Address - Fax:801-475-0419
Practice Address - Street 1:410 E NORTH 2ND ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-2258
Practice Address - Country:US
Practice Address - Phone:208-983-1131
Practice Address - Fax:208-983-9140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTH CARE CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805967300Medicaid
ID805967300Medicaid