Provider Demographics
NPI:1255671129
Name:BROOKS HOME CARE ADVANTAGE, INC
Entity Type:Organization
Organization Name:BROOKS HOME CARE ADVANTAGE, INC
Other - Org Name:BROOKS REHABILITATION HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-345-7473
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-345-7291
Mailing Address - Fax:904-345-7284
Practice Address - Street 1:3424 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4020
Practice Address - Country:US
Practice Address - Phone:386-325-4567
Practice Address - Fax:904-345-7284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS HOME CARE ADVANTAGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-28
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993785251E00000X
FL299994088251E00000X
FL299994323251E00000X
FL299994326251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109754Medicare Oscar/Certification