MEDICARE: HOMECARE ADVANTAGE,LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies	69000042A	IN
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	69000042A	IN
3	332BX2000X	Oxygen Equipment & Supplies (DME)	69000042A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124128244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMECARE ADVANTAGE,LLC

Provider Business Mailing Address
First Line	:	PO BOX 10241
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47801-0241
Country	:	US
Telephone Number	:	812-234-4602
Fax Number	:	812-234-4601

Provider Business Practice Location Address
First Line	:	185 E MCCALLISTER DR
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47802-4247
Country	:	US
Telephone Number	:	812-234-4602
Fax Number	:	812-234-4601

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARRY MARTIN
Credential	:
Telephone Number	:	812-234-4602

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	11/30/2010

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Directions to “HOMECARE ADVANTAGE,LLC ” Practice Location

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