Healthcare Provider Details

I. General information

NPI: 1619668563
Provider Name (Legal Business Name): ADVANCE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 SEVEN OAKS DR
SAINT CLOUD FL
34772-7821
US

IV. Provider business mailing address

2309 SEVEN OAKS DR
SAINT CLOUD FL
34772-7821
US

V. Phone/Fax

Practice location:
  • Phone: 407-868-4289
  • Fax:
Mailing address:
  • Phone: 407-868-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SHAWNTIA SHERICE JONES
Title or Position: OWNER/OPERATOR
Credential: RN
Phone: 140-786-8428