Healthcare Provider Details

I. General information

NPI: 1720573504
Provider Name (Legal Business Name): ADVANCE HEALTH SOCIAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WHITTIER ST STE 3
SAINT LOUIS MO
63113-2959
US

IV. Provider business mailing address

2133 SEVEN PINES DR
SAINT LOUIS MO
63146-2215
US

V. Phone/Fax

Practice location:
  • Phone: 314-535-4040
  • Fax: 314-567-1940
Mailing address:
  • Phone: 314-495-6412
  • Fax: 314-567-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMO

VIII. Authorized Official

Name: CHARLES L HILTON
Title or Position: PRESIDENT
Credential:
Phone: 314-495-6412