Provider Demographics
NPI:1356499099
Name:ADVANCED HOME HEALTH CARE AGENCY, INC
Entity Type:Organization
Organization Name:ADVANCED HOME HEALTH CARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOROSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-236-7701
Mailing Address - Street 1:104 PARK RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1750
Mailing Address - Country:US
Mailing Address - Phone:860-236-7701
Mailing Address - Fax:860-236-7708
Practice Address - Street 1:104 PARK RD
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1750
Practice Address - Country:US
Practice Address - Phone:860-236-7701
Practice Address - Fax:860-236-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT07-7242OtherCMS CERTIFICATION NUMBER
CT1356499099Medicare NSC
CT07-7242OtherCMS CERTIFICATION NUMBER