Provider Demographics
NPI:1205887452
Name:ADVANTAGE HOME CARE, INC.
Entity type:Organization
Organization Name:ADVANTAGE HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:REYNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-828-0232
Mailing Address - Street 1:PO BOX 91000
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-1000
Mailing Address - Country:US
Mailing Address - Phone:505-828-0232
Mailing Address - Fax:505-212-0790
Practice Address - Street 1:8725 ALAMEDA PARK DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2475
Practice Address - Country:US
Practice Address - Phone:505-828-0232
Practice Address - Fax:505-212-0790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NM3326251G00000X
NMCNP01260363LP2300X
NM3167251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No251G00000XAgenciesHospice Care, Community BasedGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88085830Medicaid
NM57003335Medicaid
NM321563Medicare Oscar/Certification