Advanced Life Management LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1011767 Issued in IL

Legal business name

ADVANCED LIFE MANAGEMENT LLC

Practice address

3590 Hobson Rd
Suite 402
Woodridge, IL 60517-5409

Phone

(630) 852-5700

Fax

(630) 852-6700

NPI assigned

Jul 25, 2016

Last updated

Jul 25, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrick Custardo, JD

Title

Administrator

Phone

(630) 362-4469

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469404800000",
    "number": "1710430855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3590 HOBSON RD",
            "address_2": "SUITE 402",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605175409",
            "telephone_number": "630-852-5700",
            "fax_number": "630-852-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 HOBSON RD",
            "address_2": "SUITE 402",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605175409",
            "telephone_number": "630-852-5700",
            "fax_number": "630-852-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED LIFE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-25",
        "last_updated": "2016-07-25",
        "status": "A",
        "authorized_official_last_name": "CUSTARDO",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "630-362-4469",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Home Health Agency in Woodridge, IL
• Providers in Woodridge, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.