Provider Demographics
NPI:1659537348
Name:AGE ADVANTAGE HOME CARE SERVICES
Entity Type:Organization
Organization Name:AGE ADVANTAGE HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-347-2050
Mailing Address - Street 1:525 W PLANT ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3069
Mailing Address - Country:US
Mailing Address - Phone:407-347-2050
Mailing Address - Fax:866-446-1834
Practice Address - Street 1:525 W PLANT ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3069
Practice Address - Country:US
Practice Address - Phone:407-347-2050
Practice Address - Fax:866-446-1834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19966212251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health