Provider Demographics
NPI:1023187804
Name:ADVANCED RENOVATION SOLUTIONS
Entity Type:Organization
Organization Name:ADVANCED RENOVATION SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-791-1911
Mailing Address - Street 1:21350 LA HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-7509
Mailing Address - Country:US
Mailing Address - Phone:225-791-1911
Mailing Address - Fax:225-667-7997
Practice Address - Street 1:21350 LA HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-7509
Practice Address - Country:US
Practice Address - Phone:225-791-1911
Practice Address - Fax:225-667-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1463001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1463001Medicaid
LA1470511Medicaid
LA1470546Medicaid