Provider Demographics
NPI:1982902813
Name:HOME ADVANTAGE HEALTH CARE LLC
Entity Type:Organization
Organization Name:HOME ADVANTAGE HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:WEIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-369-4221
Mailing Address - Street 1:11172 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-4006
Mailing Address - Country:US
Mailing Address - Phone:320-369-4221
Mailing Address - Fax:
Practice Address - Street 1:11172 125TH AVE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-4006
Practice Address - Country:US
Practice Address - Phone:320-369-4221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN349843251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health