MEDICARE: ADVANTAGE HOME HEALTH, 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

General Provider Information

NPI Number	:	1679737183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	7474 CREEDMOOR RD # 176
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1663
Country	:	US
Telephone Number	:	919-522-8282
Fax Number	:	919-882-9241

Provider Business Practice Location Address
First Line	:	7474 CREEDMOOR RD # 176
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27613-1663
Country	:	US
Telephone Number	:	919-522-8282
Fax Number	:	919-882-9241

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BRENDA FENNEMA
Credential	:
Telephone Number	:	919-368-5548

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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