Provider Demographics
NPI:1508875220
Name:ADVANCED HOMECARE, LLC
Entity Type:Organization
Organization Name:ADVANCED HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:LONDON-LEIB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-841-2200
Mailing Address - Street 1:2851 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-4172
Mailing Address - Country:US
Mailing Address - Phone:785-841-2200
Mailing Address - Fax:785-841-7003
Practice Address - Street 1:2851 IOWA ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4172
Practice Address - Country:US
Practice Address - Phone:785-841-2200
Practice Address - Fax:785-841-7003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5-02038332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000118112OtherBCBS OF KS
KS100455900AMedicaid
KS4558880002Medicare ID - Type Unspecified