Provider Demographics
NPI:1356943849
Name:ADVANTAGE HEALTH OF CENTRAL INDIANA LLC
Entity type:Organization
Organization Name:ADVANTAGE HEALTH OF CENTRAL INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANNERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-714-2361
Mailing Address - Street 1:830 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2643
Mailing Address - Country:US
Mailing Address - Phone:765-714-2361
Mailing Address - Fax:
Practice Address - Street 1:830 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2643
Practice Address - Country:US
Practice Address - Phone:765-714-2361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty