Provider Demographics
NPI:1689160632
Name:YOUR HOME COURT ADVANTAGE
Entity Type:Organization
Organization Name:YOUR HOME COURT ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-587-5587
Mailing Address - Street 1:7953 PITTSBURG AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5669
Mailing Address - Country:US
Mailing Address - Phone:330-587-5587
Mailing Address - Fax:330-587-5588
Practice Address - Street 1:7953 PITTSBURG AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5669
Practice Address - Country:US
Practice Address - Phone:330-587-5587
Practice Address - Fax:330-587-5588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250461Medicaid