MEDICARE: ADVANTAGEOUS COMMUNITY SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1619168770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGEOUS COMMUNITY SERVICES, LLC

Provider Business Mailing Address
First Line	:	3909 JUAN TABO BLVD NE STE 2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3973
Country	:	US
Telephone Number	:	505-266-5081
Fax Number	:	505-266-1091

Provider Business Practice Location Address
First Line	:	3909 JUAN TABO BLVD NE STE 2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3973
Country	:	US
Telephone Number	:	505-266-5081
Fax Number	:	505-266-1091

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MISS MELISSA MCCUE
Credential	:
Telephone Number	:	505-266-5081

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	08/05/2007

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