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General NPI Number Information
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NPI Number | 1669812160
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Entity Type | Organization
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Legal Business Name | ADVANTAGE HOME HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 588 CANAL BLVD SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-8603
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Country | US
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Telephone | 505-866-1407
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Fax | 505-866-1407
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Provider Business Mailing Address
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Address Line | PO BOX 2939
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City | LOS LUNAS
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State | NM
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Zip | 87031-2939
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Country | US
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Telephone | 505-866-1407
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Fax | 505-866-1407
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Authorized Official
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Title or Position | HOME HEALTH AGENCY DIRECTOR
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Name | MR. ABBAS MICHAEL KHAVARI
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Credential |
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Telephone | 505-866-1407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1T3448
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License Number State | NM
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