Provider Demographics
NPI:1215921101
Name:ADVANCED HEALTH SERVICES INC.
Entity type:Organization
Organization Name:ADVANCED HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-690-4427
Mailing Address - Street 1:PO BOX 1996
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-1910
Mailing Address - Country:US
Mailing Address - Phone:540-994-9811
Mailing Address - Fax:540-994-9760
Practice Address - Street 1:58 N WASHINGTON AVE
Practice Address - Street 2:SUITE 516
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-5732
Practice Address - Country:US
Practice Address - Phone:540-994-9811
Practice Address - Fax:540-994-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4974549Medicaid
VA4974549Medicaid