Provider Demographics
NPI:1295107753
Name:ADVANCED GROWTH, INC
Entity type:Organization
Organization Name:ADVANCED GROWTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:SIEU
Authorized Official - Middle Name:
Authorized Official - Last Name:MA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-549-8884
Mailing Address - Street 1:PO BOX 910913
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90091-0913
Mailing Address - Country:US
Mailing Address - Phone:888-549-8884
Mailing Address - Fax:888-751-6166
Practice Address - Street 1:19W706 13TH PL
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4505
Practice Address - Country:US
Practice Address - Phone:888-948-9998
Practice Address - Fax:888-776-8838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL533073-01324500000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility