Healthcare Provider Details

I. General information

NPI: 1396735627
Provider Name (Legal Business Name): ADVANTAGE HEALTH SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MAIN ST SUITE 100
COLUMBIA SC
29201-2433
US

IV. Provider business mailing address

1800 MAIN ST SUITE 100
COLUMBIA SC
29201-2433
US

V. Phone/Fax

Practice location:
  • Phone: 803-758-4000
  • Fax: 803-758-4001
Mailing address:
  • Phone: 803-758-4000
  • Fax: 803-758-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA-152
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberEXG028
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. VALERIE M AIKEN
Title or Position: VICE-PRESIDENT
Credential:
Phone: 803-758-4000