MEDICARE: ADVANCE HEALING HOME HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1083234884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE HEALING HOME HEALTHCARE

Provider Business Mailing Address
First Line	:	3614 BROOKLYN AVE APT 1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21225-2118
Country	:	US
Telephone Number	:	443-261-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	3614 BROOKLYN AVE APT 1
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21225-2118
Country	:	US
Telephone Number	:	443-261-9793
Fax Number	:

Authorized Official
Title or Position	:	BUSINESS OWNER HOME HEALTH CARE
Name	:	MRS. TOWANDA SERGENT
Credential	:	CNA, GNA, MED TECH
Telephone Number	:	443-261-9793

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	05/01/2023

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