Healthcare Provider Details

I. General information

NPI: 1780941039
Provider Name (Legal Business Name): ADVANCED HOME HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 CARLSBAD DR
GAITHERSBURG MD
20879-3203
US

IV. Provider business mailing address

1327 CARLSBAD DR
GAITHERSBURG MD
20879-3203
US

V. Phone/Fax

Practice location:
  • Phone: 301-922-7353
  • Fax: 301-519-2065
Mailing address:
  • Phone: 301-922-7353
  • Fax: 301-519-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberR3125
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR3125
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberR3125
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR3125
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR3125
License Number StateMD

VIII. Authorized Official

Name: MS. CECILY GACHENGE
Title or Position: DIRECTOR OF NURSES
Credential: DON
Phone: 240-477-0444