Provider Demographics
NPI:1629201165
Name:ADVANCED HEALTHCARE
Entity Type:Organization
Organization Name:ADVANCED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LATRESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-927-9961
Mailing Address - Street 1:911 W MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:LA
Mailing Address - Zip Code:71040-3300
Mailing Address - Country:US
Mailing Address - Phone:318-927-9961
Mailing Address - Fax:
Practice Address - Street 1:911 W MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:LA
Practice Address - Zip Code:71040-3300
Practice Address - Country:US
Practice Address - Phone:318-927-9961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty