Provider Demographics
NPI:1073976304
Name:ADVANCED HOME MEDICAL LLC
Entity Type:Organization
Organization Name:ADVANCED HOME MEDICAL LLC
Other - Org Name:TOTAL RESPIRATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-281-4421
Mailing Address - Street 1:6414 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3576
Mailing Address - Country:US
Mailing Address - Phone:270-670-6366
Mailing Address - Fax:614-433-9013
Practice Address - Street 1:4460 LAKE FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-3755
Practice Address - Country:US
Practice Address - Phone:513-813-3385
Practice Address - Fax:513-813-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-04
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0212918Medicaid