Provider Demographics
NPI:1376151100
Name:ADVENT CARE SYSTEMS HOME CARE OF OCILLA, LLC.
Entity Type:Organization
Organization Name:ADVENT CARE SYSTEMS HOME CARE OF OCILLA, LLC.
Other - Org Name:ADVENT CARE SYSTEMS OF OCILLA, LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRETTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-532-9308
Mailing Address - Street 1:501 N IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-5007
Mailing Address - Country:US
Mailing Address - Phone:912-532-9308
Mailing Address - Fax:229-299-9697
Practice Address - Street 1:501 N IRWIN AVE
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-5007
Practice Address - Country:US
Practice Address - Phone:229-468-0646
Practice Address - Fax:229-468-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP010926OtherGA HFRD HOME CARE LICENSE