Provider Demographics
NPI:1700852761
Name:ADVANTAGE HOME ASSISTED CARE, INC.
Entity Type:Organization
Organization Name:ADVANTAGE HOME ASSISTED CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:FINNIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:727-593-0878
Mailing Address - Street 1:13465 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-3528
Mailing Address - Country:US
Mailing Address - Phone:727-593-0878
Mailing Address - Fax:727-593-3240
Practice Address - Street 1:13465 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3528
Practice Address - Country:US
Practice Address - Phone:727-593-0878
Practice Address - Fax:727-593-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107693Medicare ID - Type UnspecifiedMEDICARE