Provider Demographics
NPI:1083234884
Name:ADVANCE HEALING HOME HEALTHCARE
Entity Type:Organization
Organization Name:ADVANCE HEALING HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER HOME HEALTH CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOWANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERGENT
Authorized Official - Suffix:
Authorized Official - Credentials:CNA, GNA, MED TECH
Authorized Official - Phone:443-261-9793
Mailing Address - Street 1:3614 BROOKLYN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-2118
Mailing Address - Country:US
Mailing Address - Phone:443-261-9793
Mailing Address - Fax:
Practice Address - Street 1:3614 BROOKLYN AVE APT 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2118
Practice Address - Country:US
Practice Address - Phone:443-261-9793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty