Healthcare Provider Details

I. General information

NPI: 1780672550
Provider Name (Legal Business Name): AVANTI HOME HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 BEASER AVE
ASHLAND WI
54806
US

IV. Provider business mailing address

300 VILLA DR
HURLEY WI
54534-1523
US

V. Phone/Fax

Practice location:
  • Phone: 715-682-9500
  • Fax: 715-682-9580
Mailing address:
  • Phone: 715-561-3200
  • Fax: 715-561-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number251
License Number StateWI

VIII. Authorized Official

Name: JOSEPH P SIMONICH
Title or Position: CEO
Credential:
Phone: 715-561-3200