Provider Demographics
NPI:1730365628
Name:ADVANCED COMPREHENSIVE ELDERLY CARE SERVICES, INC
Entity type:Organization
Organization Name:ADVANCED COMPREHENSIVE ELDERLY CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:813-389-9563
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:FL
Mailing Address - Zip Code:33576-0845
Mailing Address - Country:US
Mailing Address - Phone:813-389-9563
Mailing Address - Fax:352-588-3699
Practice Address - Street 1:4102 W LINEBAUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5296
Practice Address - Country:US
Practice Address - Phone:813-389-9563
Practice Address - Fax:352-588-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 30241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7448OtherGROUP NUMBER