Provider Demographics
NPI:1891923926
Name:ADVANCED HEALING CENTER LLC.
Entity type:Organization
Organization Name:ADVANCED HEALING CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAHKIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-443-5378
Mailing Address - Street 1:2942 W COLUMBUS DR
Mailing Address - Street 2:SUITE 106/107
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-2275
Mailing Address - Country:US
Mailing Address - Phone:813-443-5378
Mailing Address - Fax:813-443-5379
Practice Address - Street 1:2942 W COLUMBUS DR
Practice Address - Street 2:SUITE 106/107
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-2275
Practice Address - Country:US
Practice Address - Phone:813-443-5378
Practice Address - Fax:813-443-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51130261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center