Provider Demographics
NPI:1609173160
Name:ADVANCED COMMUNITY SUPPORT, LLC
Entity Type:Organization
Organization Name:ADVANCED COMMUNITY SUPPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-608-7139
Mailing Address - Street 1:12 CASE ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-608-7139
Mailing Address - Fax:
Practice Address - Street 1:12 CASE ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-608-7139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health