Provider Demographics
NPI:1336158757
Name:HOME CARE ADVANTAGE, INC.
Entity Type:Organization
Organization Name:HOME CARE ADVANTAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICE COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROOKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-337-4663
Mailing Address - Street 1:718 E 3RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2915
Mailing Address - Country:US
Mailing Address - Phone:330-337-4663
Mailing Address - Fax:330-337-0481
Practice Address - Street 1:718 E 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2915
Practice Address - Country:US
Practice Address - Phone:330-337-4663
Practice Address - Fax:330-337-0481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2138001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2138001Medicaid