Provider Demographics
NPI:1871100438
Name:ADVANCED HEALTHCARE PRACTICE LLC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:FAUSKA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-712-6763
Mailing Address - Street 1:7422 SHADY LAKE GRV
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3181
Mailing Address - Country:US
Mailing Address - Phone:832-519-8093
Mailing Address - Fax:832-218-3378
Practice Address - Street 1:6140 N SAM HOUSTON PKWY W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-5002
Practice Address - Country:US
Practice Address - Phone:832-519-8093
Practice Address - Fax:832-218-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care