Healthcare Provider Details

I. General information

NPI: 1427837749
Provider Name (Legal Business Name): ADVANCE HEALTH AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S GARFIELD ST APT 9
SPOKANE WA
99202-5089
US

IV. Provider business mailing address

PO BOX 4245
SPOKANE WA
99220-0245
US

V. Phone/Fax

Practice location:
  • Phone: 509-535-4525
  • Fax: 509-255-3247
Mailing address:
  • Phone: 360-839-9268
  • Fax: 509-255-3247

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RIVER HYLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 509-535-4525