=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649222746
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HOME HEALTH CARE INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 09/25/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2834 45TH STREET SUITE B
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-922-6700
-----------------------------------------------------
Fax | 219-924-3005
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2834 45TH STREET SUITE B
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46322
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-922-6700
-----------------------------------------------------
Fax | 219-924-3005
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. JEAN LAROCHE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-342-7076
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------