Provider Demographics
NPI:1215568092
Name:ADVANCED WELLNESS SERVICES CORP
Entity Type:Organization
Organization Name:ADVANCED WELLNESS SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANABIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-296-2773
Mailing Address - Street 1:14100 PALMETTO FRNTG RD STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1568
Mailing Address - Country:US
Mailing Address - Phone:786-296-2773
Mailing Address - Fax:786-565-3955
Practice Address - Street 1:14100 PALMETTO FRONTAGE RD
Practice Address - Street 2:STE 112
Practice Address - City:MIAMI LAKES
Practice Address - State:FLORIDA
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:786-536-2945
Practice Address - Fax:786-565-3955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management