Provider Demographics
NPI:1124186838
Name:ADVANCED HEARING AIDS
Entity Type:Organization
Organization Name:ADVANCED HEARING AIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:760-365-0691
Mailing Address - Street 1:56970 YUCCA TRL # 102
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3753
Mailing Address - Country:US
Mailing Address - Phone:760-365-0691
Mailing Address - Fax:760-365-0692
Practice Address - Street 1:56970 YUCCA TRL # 102
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-3753
Practice Address - Country:US
Practice Address - Phone:760-365-0691
Practice Address - Fax:760-365-0692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 1932237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ71937ZMedicaid
CAZZZ45183ZOtherBLUE SHIELD OF CALIFORNIA