Provider Demographics
NPI:1629405626
Name:ADVANCED HEALTHCARE HOSPITAL LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE HOSPITAL LLC
Other - Org Name:PIONEER SPECIALTY HOSPITAL - GARDEN CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:FAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:UDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-593-1990
Mailing Address - Street 1:30700 TELEGRAPH RD
Mailing Address - Street 2:SUITE 2504
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4524
Mailing Address - Country:US
Mailing Address - Phone:248-593-1990
Mailing Address - Fax:248-593-9120
Practice Address - Street 1:50 N PERRY ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2217
Practice Address - Country:US
Practice Address - Phone:248-338-5430
Practice Address - Fax:248-593-9120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1060000185282E00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI232039Medicare Oscar/Certification
MI230304Medicare Oscar/Certification