Provider Demographics
NPI:1548299654
Name:ADVANCARE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:ADVANCARE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR LLC MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-392-2000
Mailing Address - Street 1:2625 BUTTERFIELD RD
Mailing Address - Street 2:304S
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1234
Mailing Address - Country:US
Mailing Address - Phone:708-392-2000
Mailing Address - Fax:708-392-2008
Practice Address - Street 1:2625 BUTTERFIELD RD
Practice Address - Street 2:304S
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1234
Practice Address - Country:US
Practice Address - Phone:708-392-2000
Practice Address - Fax:708-392-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010344251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147814Medicare ID - Type UnspecifiedMEDICARE HOME HEALTH