Provider Demographics
NPI:1407914153
Name:ADVANCED HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-364-0261
Mailing Address - Street 1:10646 165TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8734
Mailing Address - Country:US
Mailing Address - Phone:708-364-9606
Mailing Address - Fax:708-364-9607
Practice Address - Street 1:900 TECHNOLOGY WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5364
Practice Address - Country:US
Practice Address - Phone:847-231-4507
Practice Address - Fax:708-364-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000642332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203000642OtherSTATE LICENSE
IL203000642OtherSTATE LICENSE