MEDICARE: ADVANTAGE HOME HEALTH CARE SERVICES 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	251E00000X	Home Health Agency	1T3448	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1T3448	OTHER	NM	NEW MEXICO DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1669812160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE HOME HEALTH CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 2939
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-2939
Country	:	US
Telephone Number	:	505-866-1407
Fax Number	:	505-866-1407

Provider Business Practice Location Address
First Line	:	588 CANAL BLVD SW
Second Line	:
City	:	LOS LUNAS
State	:	NM
Zip	:	87031-8603
Country	:	US
Telephone Number	:	505-866-1407
Fax Number	:	505-866-1407

Authorized Official
Title or Position	:	HOME HEALTH AGENCY DIRECTOR
Name	:	MR. ABBAS MICHAEL KHAVARI
Credential	:
Telephone Number	:	505-866-1407

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	06/28/2013

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