Provider Demographics
NPI:1396456414
Name:ADVANCED WELLNESS SERVICES CORP
Entity type:Organization
Organization Name:ADVANCED WELLNESS SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:SANABIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-546-2549
Mailing Address - Street 1:14100 PALMETTO FRNTG RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1568
Mailing Address - Country:US
Mailing Address - Phone:786-296-2773
Mailing Address - Fax:786-565-3955
Practice Address - Street 1:14100 PALMETTO FRNTG RD STE 107
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1568
Practice Address - Country:US
Practice Address - Phone:786-296-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113667200Medicaid