Provider Demographics
NPI:1699843813
Name:ADVANCED HOME MEDICAL
Entity Type:Organization
Organization Name:ADVANCED HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DURENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUHARIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-433-9011
Mailing Address - Street 1:6185 HUNTLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1093
Mailing Address - Country:US
Mailing Address - Phone:614-433-9011
Mailing Address - Fax:614-433-9013
Practice Address - Street 1:114 E ELM AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2649
Practice Address - Country:US
Practice Address - Phone:734-241-4901
Practice Address - Fax:734-241-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIU ME-0159322332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4292140004Medicare ID - Type Unspecified