Provider Demographics
NPI:1003835026
Name:ADVANCE REHAB & HOME HEALTH LLC
Entity Type:Organization
Organization Name:ADVANCE REHAB & HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:850-522-4770
Mailing Address - Street 1:2316 W 23RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2373
Mailing Address - Country:US
Mailing Address - Phone:850-522-4770
Mailing Address - Fax:850-522-4760
Practice Address - Street 1:2316 W 23RD ST STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2373
Practice Address - Country:US
Practice Address - Phone:850-522-4770
Practice Address - Fax:850-522-4760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8384225100000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ6AOtherBCBS OF FL
FL891217300Medicaid
FLBCBS INDUVIDUAL NUMBOtherY6894
FL891217300Medicaid
FL686809Medicare Oscar/Certification