Provider Demographics
NPI:1811189665
Name:ADVANCED SENIORS HEALTHCARE GROUP, INC
Entity Type:Organization
Organization Name:ADVANCED SENIORS HEALTHCARE GROUP, INC
Other - Org Name:ADVANCED SENIORS HEALTHCARE GROUP, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-213-6067
Mailing Address - Street 1:13001 CAPITAL ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3145
Mailing Address - Country:US
Mailing Address - Phone:248-213-6067
Mailing Address - Fax:248-419-0456
Practice Address - Street 1:13001 CAPITAL ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3145
Practice Address - Country:US
Practice Address - Phone:248-213-6067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23-9053251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
239053Medicare Oscar/Certification