Healthcare Provider Details

I. General information

NPI: 1194975326
Provider Name (Legal Business Name): ADVANTAGE IN-HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11796 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3402
US

IV. Provider business mailing address

11796 WESTLINE INDUSTRIAL DR
SAINT LOUIS MO
63146-3402
US

V. Phone/Fax

Practice location:
  • Phone: 314-282-2957
  • Fax: 314-282-2967
Mailing address:
  • Phone: 314-282-2957
  • Fax: 314-282-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN P BOSEN
Title or Position: CEO
Credential:
Phone: 314-282-2957