Advanced Clinical Health Service Corporation

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149018258 Issued in IL

Legal business name

ADVANCED CLINICAL HEALTH SERVICE CORPORATION

Practice address

2925 S Wabash Ave Ste 102
Chicago, IL 60616-3583

Phone

(773) 879-2274

Fax

(312) 225-6742

NPI assigned

Dec 6, 2017

Organization subpart

No

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

Authorized official

Name

Edrena Joy Davis, LCSWNPI 1619313889

Title

Licensed Clinical Social Worker

Phone

(773) 879-2274

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Edrena Davis

  • Behavior Analyst
  • Hazel Crest, IL
  • NPI 1619313889
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1891200317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 S WABASH AVE STE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163583",
            "telephone_number": "773-879-2274",
            "fax_number": "312-225-6742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2925 S WABASH AVE STE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606163583",
            "telephone_number": "773-879-2274",
            "fax_number": "312-225-6742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CLINICAL HEALTH SERVICE CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "EDRENA",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "LICENSED CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "773-879-2274",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Care Services, Inc
• Advanced Care Specialist Group LLC
• Advanced Care Specialist Group LLC
• Advanced Chicago Physicians
• Advanced Chiropractic Care SC
• Advanced Counseling Services, Inc.
• Advanced Dental
• Advanced Dental Care
• Advanced Dermatology and Aesthetic Medicine
• Advanced Diagnostic Services LLC

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.