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General NPI Number Information
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NPI Number | 1417027327
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Entity Type | Organization
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Legal Business Name | ADVANCED HORIZONS LLC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 6685 QUINCE RD SUITE 124
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City | MEMPHIS
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State | TN
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Zip | 38119-8038
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Country | US
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Telephone | 901-624-3581
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Fax | 901-757-3830
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Provider Business Mailing Address
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Address Line | 6685 QUINCE RD SUITE 124
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City | MEMPHIS
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State | TN
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Zip | 38119-8038
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Country | US
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Telephone | 901-624-3581
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Fax | 901-757-3830
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Authorized Official
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Title or Position | CHEIF MANAGER
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Name | STAN CAUMMISAR
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Credential |
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Telephone | 901-624-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | I 215-096-9686
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License Number State | TN
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