Provider Demographics
NPI:1922050434
Name:ADVANCED HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ADVANCED HEALTH SERVICES, INC.
Other - Org Name:ADVANCED HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALOW
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:708-372-3154
Mailing Address - Street 1:10646 165TH ST.
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-5653
Mailing Address - Country:US
Mailing Address - Phone:708-364-9606
Mailing Address - Fax:708-364-9607
Practice Address - Street 1:10646 165TH ST.
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467-5653
Practice Address - Country:US
Practice Address - Phone:708-364-9606
Practice Address - Fax:708-364-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000543332B00000X
IL203.000641332B00000X
IL203.000586332B00000X
IL203.000585332B00000X
IL203.000642332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633924OtherBCBS IL
IL01633924OtherBCBS IL
IL=========6046701Medicaid