Provider Demographics
NPI:1073999413
Name:ADVANGARDE
Entity Type:Organization
Organization Name:ADVANGARDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:WINSTON
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:609-254-0626
Mailing Address - Street 1:604 S WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4118
Mailing Address - Country:US
Mailing Address - Phone:609-254-0626
Mailing Address - Fax:609-254-0621
Practice Address - Street 1:604 S WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4118
Practice Address - Country:US
Practice Address - Phone:609-254-0626
Practice Address - Fax:609-254-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-08
Last Update Date:2015-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable