Provider Demographics
NPI:1659708634
Name:ADVANCE HOME CARE LLC
Entity Type:Organization
Organization Name:ADVANCE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SAED
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-3611
Mailing Address - Street 1:1191 S JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1800
Mailing Address - Country:US
Mailing Address - Phone:614-436-3611
Mailing Address - Fax:614-436-3813
Practice Address - Street 1:1191 S JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1800
Practice Address - Country:US
Practice Address - Phone:614-436-3611
Practice Address - Fax:614-436-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024422251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088862Medicaid