Provider Demographics
NPI:1447401039
Name:ADVANCED INDEPENDENCE
Entity Type:Organization
Organization Name:ADVANCED INDEPENDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIREDTOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-439-7080
Mailing Address - Street 1:4410 W UNION HILLS DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1660
Mailing Address - Country:US
Mailing Address - Phone:602-439-7080
Mailing Address - Fax:602-863-6385
Practice Address - Street 1:5313 W MURIEL DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5356
Practice Address - Country:US
Practice Address - Phone:602-439-7080
Practice Address - Fax:602-863-6385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251C00000X, 251G00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251G00000XAgenciesHospice Care, Community Based
No252Y00000XAgenciesEarly Intervention Provider Agency