Provider Demographics
NPI:1528592664
Name:ADVANTA MEDICAL STAFFING & CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:ADVANTA MEDICAL STAFFING & CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RES
Authorized Official - Middle Name:JUNIVIL
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:248-308-7886
Mailing Address - Street 1:61061 PREAKNESS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8215
Mailing Address - Country:US
Mailing Address - Phone:248-605-1163
Mailing Address - Fax:
Practice Address - Street 1:61061 PREAKNESS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-8215
Practice Address - Country:US
Practice Address - Phone:248-605-1163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care