Healthcare Provider Details

I. General information

NPI: 1750499570
Provider Name (Legal Business Name): ADVANCED HOME MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 HOLLAND RD STE A
MAUMEE OH
43537-1656
US

IV. Provider business mailing address

6414 S 118TH ST
OMAHA NE
68137-3576
US

V. Phone/Fax

Practice location:
  • Phone: 419-537-0116
  • Fax: 419-537-0118
Mailing address:
  • Phone: 402-933-6412
  • Fax: 402-281-4490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH

VIII. Authorized Official

Name: SHEILA ROBERSON
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 602-818-5258