Provider Demographics
NPI:1497423719
Name:ADVANCED HOME MEDICAL LLC
Entity Type:Organization
Organization Name:ADVANCED HOME MEDICAL LLC
Other - Org Name:TOTAL RESPIRATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAULS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-281-4421
Mailing Address - Street 1:6414 S 118TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3576
Mailing Address - Country:US
Mailing Address - Phone:270-670-6366
Mailing Address - Fax:614-433-9013
Practice Address - Street 1:1050 MONARCH ST STE 300B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1877
Practice Address - Country:US
Practice Address - Phone:859-559-0801
Practice Address - Fax:859-559-0805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-01
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100811800Medicaid