Provider Demographics
NPI:1053506741
Name:ADVANCED MEDICAL
Entity Type:Organization
Organization Name:ADVANCED MEDICAL
Other - Org Name:REHAB AMERICA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:615-477-2072
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-0292
Mailing Address - Country:US
Mailing Address - Phone:615-477-2072
Mailing Address - Fax:
Practice Address - Street 1:681 BEVILLE RD
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-1951
Practice Address - Country:US
Practice Address - Phone:866-426-2811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9179283X00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility