Provider Demographics
NPI:1225719925
Name:ADVANCED INDIVIDUAL SERVICES
Entity Type:Organization
Organization Name:ADVANCED INDIVIDUAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEIDISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-861-7112
Mailing Address - Street 1:5818 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66610-1234
Mailing Address - Country:US
Mailing Address - Phone:785-554-6487
Mailing Address - Fax:785-670-8113
Practice Address - Street 1:3410 SW VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2258
Practice Address - Country:US
Practice Address - Phone:785-861-7112
Practice Address - Fax:785-670-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services