Provider Demographics
NPI:1407846736
Name:ADVANTAGE HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ADVANTAGE HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-284-1211
Mailing Address - Street 1:4008 N WHEELING AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-1427
Mailing Address - Country:US
Mailing Address - Phone:765-284-1211
Mailing Address - Fax:765-284-1239
Practice Address - Street 1:4008 N WHEELING AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-1427
Practice Address - Country:US
Practice Address - Phone:765-284-1211
Practice Address - Fax:765-284-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN007116251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100374770Medicaid
IN100374780OtherMEDICAID WAIVER
000000098092OtherANTHEM BC/BS
000000098092OtherANTHEM BC/BS