Provider Demographics
NPI:1417027327
Name:ADVANCED HORIZONS LLC
Entity Type:Organization
Organization Name:ADVANCED HORIZONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUMMISAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-624-3581
Mailing Address - Street 1:6685 QUINCE RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8038
Mailing Address - Country:US
Mailing Address - Phone:901-624-3581
Mailing Address - Fax:901-757-3830
Practice Address - Street 1:6685 QUINCE RD
Practice Address - Street 2:SUITE 124
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8038
Practice Address - Country:US
Practice Address - Phone:901-624-3581
Practice Address - Fax:901-757-3830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI 215-096-9686261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health