Provider Demographics
NPI:1831801539
Name:ADVANCED HOME MEDICAL LLC
Entity type:Organization
Organization Name:ADVANCED HOME MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERPOOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-771-6501
Mailing Address - Street 1:8320 YANKEE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1808
Mailing Address - Country:US
Mailing Address - Phone:614-433-9011
Mailing Address - Fax:614-433-9033
Practice Address - Street 1:8320 YANKEE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1808
Practice Address - Country:US
Practice Address - Phone:937-759-8710
Practice Address - Fax:937-759-8711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HOME MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-14
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies