Healthcare Provider Details

I. General information

NPI: 1629405626
Provider Name (Legal Business Name): ADVANCED HEALTHCARE HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N PERRY ST 6TH FLOOR
PONTIAC MI
48342-2217
US

IV. Provider business mailing address

30700 TELEGRAPH RD SUITE 2504
BINGHAM FARMS MI
48025-4524
US

V. Phone/Fax

Practice location:
  • Phone: 248-338-5430
  • Fax: 248-593-9120
Mailing address:
  • Phone: 248-593-1990
  • Fax: 248-593-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number1060000185
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: FAHIM UDDIN
Title or Position: SOLE MEMBER
Credential:
Phone: 248-593-1990