Provider Demographics
NPI:1740841840
Name:AVANCE INC.
Entity type:Organization
Organization Name:AVANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATUL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:773-293-1770
Mailing Address - Street 1:4765 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2077
Mailing Address - Country:US
Mailing Address - Phone:773-293-1770
Mailing Address - Fax:773-293-3890
Practice Address - Street 1:4765 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2077
Practice Address - Country:US
Practice Address - Phone:773-293-1770
Practice Address - Fax:773-293-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children