Provider Demographics
NPI:1033111208
Name:ALLEGHENY HEALTH NETWORK HOME INFUSION LLC
Entity Type:Organization
Organization Name:ALLEGHENY HEALTH NETWORK HOME INFUSION LLC
Other - Org Name:VANTAGE HME LIMITED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-337-0000
Mailing Address - Street 1:1305 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3036
Mailing Address - Country:US
Mailing Address - Phone:855-693-2286
Mailing Address - Fax:888-704-4877
Practice Address - Street 1:1305 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3036
Practice Address - Country:US
Practice Address - Phone:855-693-2286
Practice Address - Fax:888-704-4877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413955L251F00000X
PAPP413955L83105333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3968647OtherNCPDP
PA1007613480002Medicaid
PA0383290001Medicare ID - Type UnspecifiedHOME INFUSION THERAPY SER