Provider Demographics
NPI:1780792507
Name:ADVANCED HOME MEDICAL LLC
Entity type:Organization
Organization Name:ADVANCED HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DURENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUHARIK
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:614-433-9011
Mailing Address - Street 1:300 W NATIONAL RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1442
Mailing Address - Country:US
Mailing Address - Phone:937-836-4544
Mailing Address - Fax:937-836-4611
Practice Address - Street 1:300 W NATIONAL RD
Practice Address - Street 2:SUITE C
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1442
Practice Address - Country:US
Practice Address - Phone:937-836-4544
Practice Address - Fax:937-836-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2707182Medicaid
OH2707182Medicaid