Provider Demographics
NPI:1578077731
Name:BROOKS HOME CARE ADVANTAGE, INC.
Entity Type:Organization
Organization Name:BROOKS HOME CARE ADVANTAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-345-7473
Mailing Address - Street 1:6676 CORPORATE CENTER PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-0108
Mailing Address - Country:US
Mailing Address - Phone:904-722-1515
Mailing Address - Fax:
Practice Address - Street 1:3424 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4020
Practice Address - Country:US
Practice Address - Phone:386-325-4567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKS HOME CARE ADVANTAGE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-27
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health