Provider Demographics
NPI:1720573504
Name:ADVANCE HEALTH SOCIAL SERVICES INC
Entity Type:Organization
Organization Name:ADVANCE HEALTH SOCIAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-495-6412
Mailing Address - Street 1:2133 SEVEN PINES DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-2215
Mailing Address - Country:US
Mailing Address - Phone:314-495-6412
Mailing Address - Fax:314-567-1940
Practice Address - Street 1:2601 WHITTIER ST STE 3
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-2959
Practice Address - Country:US
Practice Address - Phone:314-535-4040
Practice Address - Fax:314-567-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261QA0600XMedicaid