Provider Demographics
NPI:1851327787
Name:ADVANCED SENIOR SUPPORT MEDICAL SERVICES LLC
Entity Type:Organization
Organization Name:ADVANCED SENIOR SUPPORT MEDICAL SERVICES LLC
Other - Org Name:ADVANCED SENIOR SUPPORT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-891-7480
Mailing Address - Street 1:855 S. SUNBURY RD SUITE 206
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081
Mailing Address - Country:US
Mailing Address - Phone:614-891-7480
Mailing Address - Fax:614-891-7430
Practice Address - Street 1:855 S. SUNBURY RD SUITE 206
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-891-7480
Practice Address - Fax:614-891-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2742492Medicaid