Healthcare Provider Details

I. General information

NPI: 1487122578
Provider Name (Legal Business Name): HOME ADVANTAGE LIVING ASSISTANCE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OAKLEAF DRIVE
EASTABOGA AL
36260
US

IV. Provider business mailing address

15 OAKLEAF DR
EASTABOGA AL
36260-5164
US

V. Phone/Fax

Practice location:
  • Phone: 256-403-1943
  • Fax:
Mailing address:
  • Phone: 256-403-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANNA WAITS YANCEY
Title or Position: OWNER
Credential:
Phone: 256-403-1943