Provider Demographics
NPI:1801316252
Name:ADVANCING INDEPENDENCE, INC
Entity type:Organization
Organization Name:ADVANCING INDEPENDENCE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:LGHA
Authorized Official - Phone:559-558-2875
Mailing Address - Street 1:4630 W JACQUELYN AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6431
Mailing Address - Country:US
Mailing Address - Phone:559-275-2324
Mailing Address - Fax:559-275-2329
Practice Address - Street 1:4630 W JACQUELYN AVE STE 116
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6431
Practice Address - Country:US
Practice Address - Phone:559-275-2324
Practice Address - Fax:559-275-2329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY OPTION, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801316252Medicaid