Provider Demographics
NPI:1083947972
Name:ADVANCED DISABILITY SERVICES, INC
Entity Type:Organization
Organization Name:ADVANCED DISABILITY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATSOULEAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-929-7454
Mailing Address - Street 1:7020 SW COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-2615
Mailing Address - Country:US
Mailing Address - Phone:541-929-7454
Mailing Address - Fax:
Practice Address - Street 1:7020 SW COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333-2615
Practice Address - Country:US
Practice Address - Phone:541-929-7454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR90025176060909D320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities