Healthcare Provider Details

I. General information

NPI: 1245529031
Provider Name (Legal Business Name): ADVANCED PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SOUTH SPRUCE STREET
BATES CITY MO
64011-9707
US

IV. Provider business mailing address

901 S SPRUCE ST
BATES CITY MO
64011-9707
US

V. Phone/Fax

Practice location:
  • Phone: 816-896-0416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2011007384
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JO HILBRENNER
Title or Position: FNP/OWNER
Credential: ARNP
Phone: 816-896-0416