Provider Demographics
NPI:1316084262
Name:ADVANCED HOME SUPPORT, INC.
Entity type:Organization
Organization Name:ADVANCED HOME SUPPORT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-430-1500
Mailing Address - Street 1:15800 CRABBS BRANCH WAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2604
Mailing Address - Country:US
Mailing Address - Phone:240-430-1500
Mailing Address - Fax:888-522-6946
Practice Address - Street 1:15800 CRABBS BRANCH WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2604
Practice Address - Country:US
Practice Address - Phone:240-430-1500
Practice Address - Fax:888-522-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2467P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health