Provider Demographics
NPI:1932370871
Name:ADVANTAGE HOME CARE LLC
Entity Type:Organization
Organization Name:ADVANTAGE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KELLOGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-990-5820
Mailing Address - Street 1:903 RCR 4520
Mailing Address - Street 2:
Mailing Address - City:POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75472
Mailing Address - Country:US
Mailing Address - Phone:863-990-5820
Mailing Address - Fax:903-598-3173
Practice Address - Street 1:903 RCR 4520
Practice Address - Street 2:
Practice Address - City:POINT
Practice Address - State:TX
Practice Address - Zip Code:75472
Practice Address - Country:US
Practice Address - Phone:863-990-5820
Practice Address - Fax:903-598-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service