Provider Demographics
NPI:1346398351
Name:ADVANCED HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:CAOILI
Authorized Official - Last Name:AGNO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:217-726-6956
Mailing Address - Street 1:3900 PINTAIL DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7380
Mailing Address - Country:US
Mailing Address - Phone:217-726-6956
Mailing Address - Fax:217-726-7082
Practice Address - Street 1:3900 PINTAIL DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62711-7380
Practice Address - Country:US
Practice Address - Phone:217-726-6956
Practice Address - Fax:217-726-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010686251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204562962001Medicaid
IL147945Medicare Oscar/Certification
IL14-7945Medicare PIN