Provider Demographics
NPI:1437156023
Name:ADVANTAGE HOME CARE INCORPORATED
Entity Type:Organization
Organization Name:ADVANTAGE HOME CARE INCORPORATED
Other - Org Name:ADVANTAGE HOSPICE CARE INCORPORATED
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-262-4484
Mailing Address - Street 1:1611 W HARRY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3653
Mailing Address - Country:US
Mailing Address - Phone:316-262-4484
Mailing Address - Fax:316-262-5270
Practice Address - Street 1:1611 W HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3653
Practice Address - Country:US
Practice Address - Phone:316-262-4484
Practice Address - Fax:316-262-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA087058251E00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171552Medicare ID - Type UnspecifiedHOSPICE
KS178023Medicare ID - Type UnspecifiedHOME HEALTH