Provider Demographics
NPI:1720742125
Name:ADVANCE COMMUNITY SERVICES CORP
Entity Type:Organization
Organization Name:ADVANCE COMMUNITY SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-608-0710
Mailing Address - Street 1:1010 10TH AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2167
Mailing Address - Country:US
Mailing Address - Phone:786-506-9008
Mailing Address - Fax:
Practice Address - Street 1:1010 10TH AVE N STE 2
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-2167
Practice Address - Country:US
Practice Address - Phone:786-506-9008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty