Provider Demographics
NPI:1942431044
Name:ADVANCE HOME CARE SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCE HOME CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEIYANAH
Authorized Official - Middle Name:MAGEE
Authorized Official - Last Name:RATLEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-822-4438
Mailing Address - Street 1:317 N. BROAD STREET SUITE 207
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-822-4438
Mailing Address - Fax:504-822-4439
Practice Address - Street 1:317 N. BROAD STREET SUITE 207
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119
Practice Address - Country:US
Practice Address - Phone:504-822-4438
Practice Address - Fax:504-822-4439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
LA15264251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1893706Medicaid