Provider Demographics
NPI:1679975882
Name:ADVANCE GLOBAL USA, LLC
Entity type:Organization
Organization Name:ADVANCE GLOBAL USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBRIMA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIDIBEH
Authorized Official - Suffix:
Authorized Official - Credentials:FCCA
Authorized Official - Phone:614-436-3451
Mailing Address - Street 1:1491 DOBSON SQUARE NORTH
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229
Mailing Address - Country:US
Mailing Address - Phone:614-436-3451
Mailing Address - Fax:614-288-2699
Practice Address - Street 1:1491 DOBSON SQUARE NORTH
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-436-3451
Practice Address - Fax:614-288-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
OH305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No305S00000XManaged Care OrganizationsPoint of Service