Healthcare Provider Details

I. General information

NPI: 1437156023
Provider Name (Legal Business Name): ADVANTAGE HOME CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRY ST
WICHITA KS
67213-3653
US

IV. Provider business mailing address

1611 W HARRY ST
WICHITA KS
67213-3653
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-4484
  • Fax: 316-262-5270
Mailing address:
  • Phone: 316-262-4484
  • Fax: 316-262-5270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA087058
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberA087058
License Number StateKS

VIII. Authorized Official

Name: PAULA STROUD
Title or Position: OWNER
Credential:
Phone: 316-262-4484