MEDICARE: ADVANCED HEALTH 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1841763216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	1320 FORT STEVENS DR NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5027
Country	:	US
Telephone Number	:	202-722-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 FORT STEVENS DR NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-5027
Country	:	US
Telephone Number	:	202-722-5220
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. TIMOTHY OLAWUNI JR.
Credential	:
Telephone Number	:	202-722-5220

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	01/08/2019

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