Provider Demographics
NPI:1245569060
Name:ADVANCE DD CARE, LLC
Entity Type:Organization
Organization Name:ADVANCE DD CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KOSSIVI
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:DJAGLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-500-1224
Mailing Address - Street 1:PO BOX 20141
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0141
Mailing Address - Country:US
Mailing Address - Phone:614-500-1224
Mailing Address - Fax:614-364-7469
Practice Address - Street 1:545 METRO PL S STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5353
Practice Address - Country:US
Practice Address - Phone:614-500-1224
Practice Address - Fax:614-364-7469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriverGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2945880Medicaid