=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215089511
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 DIVISION AVE
-----------------------------------------------------
City | BROOKINGS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57006-2952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-692-7852
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 810
-----------------------------------------------------
City | BROOKINGS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57006-0810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO PRESIDENT
-----------------------------------------------------
Name | LARRY FRANKLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-692-7852
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------