Provider Demographics
NPI:1619168770
Name:ADVANTAGEOUS COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANTAGEOUS COMMUNITY SERVICES, LLC
Other - Org Name:IMAGINE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-266-5081
Mailing Address - Street 1:3909 JUAN TABO BLVD NE STE 2
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3973
Mailing Address - Country:US
Mailing Address - Phone:505-266-5081
Mailing Address - Fax:505-266-1091
Practice Address - Street 1:3909 JUAN TABO BLVD NE STE 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3973
Practice Address - Country:US
Practice Address - Phone:505-266-5081
Practice Address - Fax:505-266-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services