Provider Demographics
NPI:1336475607
Name:ADVANCED HOME HEALTH OF TAMPA, INC.
Entity Type:Organization
Organization Name:ADVANCED HOME HEALTH OF TAMPA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-237-3456
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:SUITE 100 W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-237-3456
Mailing Address - Fax:813-237-4567
Practice Address - Street 1:3903 NORTHDALE BLVD
Practice Address - Street 2:SUITE 100 W
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1864
Practice Address - Country:US
Practice Address - Phone:813-237-3456
Practice Address - Fax:813-237-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109656Medicare Oscar/Certification