Organization
ADVANCED HEALTH SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW MOUTON PH.D. (OWNER)
(708) 364-0261
Entity
Organization
Contact information
Practice address
900 TECHNOLOGY WAY, SUITE 120, LIBERTYVILLE, IL 60048-5364
(847) 231-4507
(708) 364-9607
Mailing address
10646 165TH ST, ORLAND PARK, IL 60467-8734
(708) 364-9606
(708) 364-9607
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
203000642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
203000642
STATE LICENSE
IL
Enumeration date
12/05/2006
Last updated
04/29/2014
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