Organization
ADVANCE SUPPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOTIA DIOKE ELVIS (CEO)
(225) 938-6657
Entity
Organization
Contact information
Practice address
972 GOLD FINCH LN, FORNEY, TX 75126-2340
(225) 938-6657
Mailing address
300 8TH ST SE UNIT 472, ALTOONA, IA 50009-7012
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/04/2023
Last updated
07/05/2023
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