Basic Information
| Provider Information | |||||||||
| NPI: | 1629405626 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED HEALTHCARE HOSPITAL LLC | ||||||||
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| OtherOrganizationName: | PIONEER SPECIALTY HOSPITAL - GARDEN CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30700 TELEGRAPH RD | ||||||||
| Address2: | SUITE 2504 | ||||||||
| City: | BINGHAM FARMS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480254524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485931990 | ||||||||
| FaxNumber: | 2485939120 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 N PERRY ST | ||||||||
| Address2: | 6TH FLOOR | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483422217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483385430 | ||||||||
| FaxNumber: | 2485939120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2013 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | UDDIN | ||||||||
| AuthorizedOfficialFirstName: | FAHIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2485931990 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | N | Hospitals | General Acute Care Hospital | 282E00000X | 1060000185 | MI | Y | Hospitals | Long Term Care Hospital |
No ID Information.