MEDICARE: ADVANTAGE HOME CARE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	008014	TX

General Provider Information

NPI Number	:	1093793481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE HOME CARE INC.

Provider Business Mailing Address
First Line	:	6421 CAMP BOWIE BLVD
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5401
Country	:	US
Telephone Number	:	817-737-4300
Fax Number	:	817-737-4305

Provider Business Practice Location Address
First Line	:	6421 CAMP BOWIE BLVD
Second Line	:	SUITE 100
City	:	FORT WORTH
State	:	TX
Zip	:	76116-5401
Country	:	US
Telephone Number	:	817-737-4300
Fax Number	:	817-737-4305

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	KAYLA SLATER
Credential	:	RN
Telephone Number	:	817-737-4300

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	08/22/2020

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