Provider Demographics
NPI:1780672550
Name:AVANTI HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:AVANTI HOME HEALTH SERVICES, LLC
Other - Org Name:AVANTI HOME HEALTH SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMONICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-561-3200
Mailing Address - Street 1:300 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54534-1523
Mailing Address - Country:US
Mailing Address - Phone:715-561-3200
Mailing Address - Fax:715-561-5556
Practice Address - Street 1:1601 BEASER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-682-9500
Practice Address - Fax:715-682-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43103800Medicaid
WI527225Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER