Provider Demographics
NPI:1104131291
Name:ADVANCE THE KINGDOM
Entity type:Organization
Organization Name:ADVANCE THE KINGDOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ADINA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-375-4459
Mailing Address - Street 1:380 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-3708
Mailing Address - Country:US
Mailing Address - Phone:724-375-4457
Mailing Address - Fax:
Practice Address - Street 1:380 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-3708
Practice Address - Country:US
Practice Address - Phone:724-375-4457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA15933601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102369218Medicaid