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Organization

ADVANCED SUPPORTED LIVING SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL JAMES CHURCHILL RN (CHIEF EXECUTIVE OFFICER)
(480) 548-7446
Entity
Organization

Contact information

Practice address
20403 N LAKE PLEASANT RD, SUITE 117-232, PEORIA, AZ 85382-9702
(480) 548-7446
(480) 907-1744
Mailing address
20403 N LAKE PLEASANT RD, SUITE 117-232, PEORIA, AZ 85382-9702
(480) 548-7446
(480) 907-1744

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
253Z00000X
In Home Supportive Care Agency

Other

Enumeration date
07/18/2016
Last updated
07/18/2016
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