Healthcare Provider Details

I. General information

NPI: 1215280292
Provider Name (Legal Business Name): ADVANCED HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 VILLA SHOPPING CENTER
NEW MADRID MO
63869-1230
US

IV. Provider business mailing address

PO BOX 487
NEW MADRID MO
63869-0487
US

V. Phone/Fax

Practice location:
  • Phone: 573-748-5757
  • Fax: 573-748-5382
Mailing address:
  • Phone: 573-748-5757
  • Fax: 573-748-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANNE IVY
Title or Position: MEMBER
Credential:
Phone: 573-748-5757