Provider Demographics
NPI:1083192165
Name:ADVANCED HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:CAOILI
Authorized Official - Last Name:AGNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-726-6956
Mailing Address - Street 1:1749 W GOLF RD # 279
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-4025
Mailing Address - Country:US
Mailing Address - Phone:630-310-0095
Mailing Address - Fax:
Practice Address - Street 1:3900 PINTAIL DR STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7380
Practice Address - Country:US
Practice Address - Phone:217-726-6959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTHCARE SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty