MEDICARE: ADVANCED HOME HEALTH NORTHWEST LLC

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

General Provider Information

NPI Number	:	1477929776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED HOME HEALTH NORTHWEST LLC

Provider Business Mailing Address
First Line	:	2365 NORTHSIDE DR STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2720
Country	:	US
Telephone Number	:	888-871-0766
Fax Number	:	866-551-0846

Provider Business Practice Location Address
First Line	:	1558 SW NANCY WAY STE 140
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97702-3216
Country	:	US
Telephone Number	:	541-241-3369
Fax Number	:	541-244-2443

Authorized Official
Title or Position	:	CFO
Name	:	STEVE MURPHY
Credential	:
Telephone Number	:	619-757-2700

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	04/02/2025

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