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General NPI Number Information
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NPI Number | 1104178177
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Entity Type | Organization
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Legal Business Name | ADVANCED HOME CARE, LLC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/16/2012
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Provider Practice Location Address
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Address Line | 39 VILLA SHOPPING CTR
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City | NEW MADRID
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State | MO
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Zip | 63869-1230
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Country | US
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Telephone | 573-748-5757
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Fax | 573-748-5382
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Provider Business Mailing Address
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Address Line | PO BOX 487
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City | NEW MADRID
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State | MO
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Zip | 63869-0487
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Country | US
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Telephone | 573-748-5757
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Fax | 573-748-5382
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. DIANNE IVY
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Credential |
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Telephone | 573-748-5757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State | NULL
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