Provider Demographics
NPI:1396735627
Name:ADVANTAGE HEALTH SYSTEMS, INC.
Entity type:Organization
Organization Name:ADVANTAGE HEALTH SYSTEMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-758-4000
Mailing Address - Street 1:1800 MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2433
Mailing Address - Country:US
Mailing Address - Phone:803-758-4000
Mailing Address - Fax:803-758-4001
Practice Address - Street 1:1800 MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2433
Practice Address - Country:US
Practice Address - Phone:803-758-4000
Practice Address - Fax:803-758-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCEXG028251J00000X
253Z00000X
SCHHA-152251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC471092Medicaid
SC471092Medicaid
SC471092Medicaid