Organization Active NPI

Advance Sam Care

  • In Home Supportive Care Agency
  • West Palm Beach, FL
National Provider Identifier
1699462960
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
In Home Supportive Care AgencyTaxonomy code 253Z00000X
Legal business name
ADVANCE SAM CARE
Practice address
2101 Vista Pkwy Ste 200
West Palm Beach, FL 33411-2706
Phone
(561) 228-7450
NPI assigned
Apr 18, 2023
Last updated
Apr 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tibab Delisser
Title
Owner
Phone
(561) 228-7450

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X NU
In Home Supportive Care Agency 253Z00000X NU Primary

Addresses

Primary practice location

2101 Vista Pkwy Ste 200
West Palm Beach, FL 33411-2706

Mailing address

2101 Vista Pkwy Ste 200
West Palm Beach, FL 33411-2706
Phone (561) 228-7450

Other identifiers 1

IdentifierTypeStateIssuer
112869600MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Advance Sam Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681776000000",
    "number": "1699462960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 VISTA PKWY STE 200",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334112706",
            "telephone_number": "561-228-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 VISTA PKWY STE 200",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334112706",
            "telephone_number": "561-228-7450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE SAM CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-18",
        "last_updated": "2023-04-18",
        "certification_date": "2021-12-15",
        "status": "A",
        "authorized_official_last_name": "DELISSER",
        "authorized_official_first_name": "TIBAB",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "561-228-7450"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112869600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.