=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437334430
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANTAGE HOME CARE SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 01/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 780 UNIVERSITY AVE W
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-4805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-645-9011
-----------------------------------------------------
Fax | 651-644-5595
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 780 UNIVERSITY AVE W
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55104-4805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-645-9011
-----------------------------------------------------
Fax | 651-644-5595
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PROFESSIONAL SERVICES
-----------------------------------------------------
Name | MRS. BLESSING U ANYANWU
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 651-645-9011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 335076
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------