Organization
ADVANCE SAM CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIBAB DELISSER (OWNER)
(561) 228-7450
Entity
Organization
Contact information
Practice address
2101 VISTA PKWY STE 200, WEST PALM BEACH, FL 33411-2706
(561) 228-7450
Mailing address
2101 VISTA PKWY STE 200, WEST PALM BEACH, FL 33411-2706
(561) 228-7450
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112869600
—
FL
Enumeration date
04/18/2023
Last updated
04/18/2023
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