Provider Demographics
NPI:1912627720
Name:AVANCE HEALTH LLC
Entity Type:Organization
Organization Name:AVANCE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:630-532-1623
Mailing Address - Street 1:513 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2624
Mailing Address - Country:US
Mailing Address - Phone:630-532-1623
Mailing Address - Fax:
Practice Address - Street 1:513 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2624
Practice Address - Country:US
Practice Address - Phone:630-532-1623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty