Provider Demographics
NPI:1457644437
Name:ADVANCED ACTION THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED ACTION THERAPY SERVICES, INC.
Other - Org Name:ACTION THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:JENE
Authorized Official - Last Name:VANNOY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, SLP-CCC
Authorized Official - Phone:817-595-2955
Mailing Address - Street 1:7904 NE LOOP 820
Mailing Address - Street 2:SUITE C & D
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7395
Mailing Address - Country:US
Mailing Address - Phone:817-595-2955
Mailing Address - Fax:817-595-5764
Practice Address - Street 1:7904 NE LOOP 820
Practice Address - Street 2:SUITE C & D
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7395
Practice Address - Country:US
Practice Address - Phone:817-595-2955
Practice Address - Fax:817-595-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX014466251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285946401Medicaid