Provider Demographics
NPI:1225635873
Name:ADVANCED CAPABILITIES
Entity Type:Organization
Organization Name:ADVANCED CAPABILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:STEVE
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:862-220-2682
Mailing Address - Street 1:413 CONOVER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-1207
Mailing Address - Country:US
Mailing Address - Phone:732-727-2562
Mailing Address - Fax:
Practice Address - Street 1:413 CONOVER ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08879-1207
Practice Address - Country:US
Practice Address - Phone:732-727-2562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty