Provider Demographics
NPI:1518129295
Name:ADVANCE CARE INCORPORATED
Entity Type:Organization
Organization Name:ADVANCE CARE INCORPORATED
Other - Org Name:ADVANCE CARE INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARGRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-738-4986
Mailing Address - Street 1:PO BOX 74484
Mailing Address - Street 2:
Mailing Address - City:ROMULUS
Mailing Address - State:MI
Mailing Address - Zip Code:48174-0484
Mailing Address - Country:US
Mailing Address - Phone:248-738-4986
Mailing Address - Fax:248-738-5682
Practice Address - Street 1:34932 ECORSE RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1642
Practice Address - Country:US
Practice Address - Phone:248-738-4986
Practice Address - Fax:248-738-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS820251656323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility