Organization
ADVANCED CARE GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOSES IRUBOR (ADMINISTRATOR)
(702) 216-0377
Entity
Organization
Contact information
Practice address
6293 DEAN MARTIN DR STE D-G, LAS VEGAS, NV 89118-3845
(281) 235-3417
Mailing address
6293 DEAN MARTIN DR, LAS VEGAS, NV 89118-3845
(702) 216-0377
(702) 216-0339
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
297202
MEDICARE PTAN
NV
Enumeration date
12/11/2013
Last updated
02/16/2021
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