Provider Demographics
NPI:1689966640
Name:ADVANTAGE MEDICAL LLC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL LLC
Other - Org Name:LAMM FAMILY CARE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:D
Authorized Official - Last Name:DORE'
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-783-0000
Mailing Address - Street 1:210 W MILL ST
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5656
Mailing Address - Country:US
Mailing Address - Phone:337-704-0237
Mailing Address - Fax:337-704-2442
Practice Address - Street 1:210 W MILL ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5656
Practice Address - Country:US
Practice Address - Phone:337-704-0237
Practice Address - Fax:337-704-2442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2337742Medicaid
LA2337742Medicaid