Provider Demographics
NPI:1871172007
Name:ADVANCED HOME AND COMMUNITY SUPPORT SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCED HOME AND COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHURLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-809-6666
Mailing Address - Street 1:606 ORIOLE BLVD STE 313
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3500
Mailing Address - Country:US
Mailing Address - Phone:972-809-6666
Mailing Address - Fax:972-283-8037
Practice Address - Street 1:606 ORIOLE BLVD STE 313
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3500
Practice Address - Country:US
Practice Address - Phone:972-809-6666
Practice Address - Fax:972-283-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities