Provider Demographics
NPI:1699475301
Name:ADVANCE HEALTHCARE CENTER CORP
Entity type:Organization
Organization Name:ADVANCE HEALTHCARE CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IBIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-287-5127
Mailing Address - Street 1:14480 SW 160TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-1700
Mailing Address - Country:US
Mailing Address - Phone:786-287-5127
Mailing Address - Fax:
Practice Address - Street 1:14480 SW 160TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1700
Practice Address - Country:US
Practice Address - Phone:786-287-5127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-09
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty