Provider Demographics
NPI:1134161318
Name:ADVENTHEALTH HOME HEALTH AND HOSPICE INC
Entity type:Organization
Organization Name:ADVENTHEALTH HOME HEALTH AND HOSPICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-545-1409
Mailing Address - Street 1:770 W GRANADA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5179
Mailing Address - Country:US
Mailing Address - Phone:863-231-4252
Mailing Address - Fax:386-231-2560
Practice Address - Street 1:770 W GRANADA BLVD STE 319
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5180
Practice Address - Country:US
Practice Address - Phone:386-673-3121
Practice Address - Fax:386-677-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA215580961251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH5MOtherBLUE CROSS BLUE SHIELD FL
FL592951990001OtherCHAMPUS
FL107408Medicare Oscar/Certification
FLH5MOtherBLUE CROSS BLUE SHIELD FL