Healthcare Provider Details

I. General information

NPI: 1447401039
Provider Name (Legal Business Name): ADVANCED INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5313 W MURIEL DR
GLENDALE AZ
85308-5356
US

IV. Provider business mailing address

4410 W UNION HILLS DR SUITE 7
GLENDALE AZ
85308-1660
US

V. Phone/Fax

Practice location:
  • Phone: 602-439-7080
  • Fax: 602-863-6385
Mailing address:
  • Phone: 602-439-7080
  • Fax: 602-863-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name: CYNTHIA LYNNE MOODY
Title or Position: CEO/DIREDTOR
Credential:
Phone: 602-439-7080