Healthcare Provider Details

I. General information

NPI: 1053551879
Provider Name (Legal Business Name): ADVANTAGE HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11510 W LANGFORD CT
YOUNGTOWN AZ
85363-1426
US

IV. Provider business mailing address

11510 W LANGFORD CT
YOUNGTOWN AZ
85363-1426
US

V. Phone/Fax

Practice location:
  • Phone: 480-235-1244
  • Fax: 480-304-3100
Mailing address:
  • Phone: 480-235-1244
  • Fax: 480-304-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALH-7015
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberALH7346H
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number410906
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number410906
License Number StateAZ

VIII. Authorized Official

Name: MR. MIRCEA BUZILA
Title or Position: OWNER / MANAGER
Credential:
Phone: 480-235-1244