Provider Demographics
NPI:1386839900
Name:ADVENT HOME HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:ADVENT HOME HEALTH CARE SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAKONNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAKLEAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-852-1985
Mailing Address - Street 1:1128 E ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3772
Mailing Address - Country:US
Mailing Address - Phone:626-852-1985
Mailing Address - Fax:626-852-7837
Practice Address - Street 1:1128 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3772
Practice Address - Country:US
Practice Address - Phone:626-852-1985
Practice Address - Fax:626-852-7837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98001019251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA557684Medicare Oscar/Certification