Provider Demographics
NPI:1790097889
Name:ADVANTAGE HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:ADVANTAGE HOME HEALTH CARE, INC.
Other - Org Name:ALLEGIANCE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:W
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-932-6877
Mailing Address - Street 1:1810 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:COUSHATTA
Mailing Address - State:LA
Mailing Address - Zip Code:71019-0763
Mailing Address - Country:US
Mailing Address - Phone:318-932-6877
Mailing Address - Fax:318-932-5433
Practice Address - Street 1:1810 FRONT STREET
Practice Address - Street 2:
Practice Address - City:COUSHATTA
Practice Address - State:LA
Practice Address - Zip Code:71019-0763
Practice Address - Country:US
Practice Address - Phone:318-932-6877
Practice Address - Fax:318-932-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11716253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1816159Medicaid