Provider Demographics
NPI:1730525395
Name:ADVANCED HEARING HEALTHCARE, LLC
Entity type:Organization
Organization Name:ADVANCED HEARING HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:GADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:815-291-4710
Mailing Address - Street 1:610 S PARK CREST DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-7802
Mailing Address - Country:US
Mailing Address - Phone:815-233-3277
Mailing Address - Fax:
Practice Address - Street 1:610 S PARK CREST DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-7802
Practice Address - Country:US
Practice Address - Phone:815-233-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AUDIOLOGY HOLDING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty