Provider Demographics
NPI:1306192117
Name:ADVANCED HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED HOME HEALTH CARE, LLC
Other - Org Name:ADVANCED HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/DON
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-680-8427
Mailing Address - Street 1:204 E FRONTVIEW ST
Mailing Address - Street 2:P.O. BOX 1573
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-5063
Mailing Address - Country:US
Mailing Address - Phone:316-680-8427
Mailing Address - Fax:620-225-4286
Practice Address - Street 1:204 E FRONTVIEW ST
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-5063
Practice Address - Country:US
Practice Address - Phone:316-680-8427
Practice Address - Fax:620-225-4286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health