=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295386712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENT HOME HEALTH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2019
-----------------------------------------------------
Last Update Date | 09/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6001 W CENTER ST STE 200
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53210-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-369-4440
-----------------------------------------------------
Fax | 833-833-4806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6001 W CENTER ST STE 200
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53210-2154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 414-369-4440
-----------------------------------------------------
Fax | 833-833-4806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MR. GABRIEL E IKPEME
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 414-807-9142
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------