MEDICARE: YOUR HOME COURT ADVANTAGE

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

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	:	1689160632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HOME COURT ADVANTAGE

Provider Business Mailing Address
First Line	:	7953 PITTSBURG AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-5669
Country	:	US
Telephone Number	:	330-587-5587
Fax Number	:	330-587-5588

Provider Business Practice Location Address
First Line	:	7953 PITTSBURG AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-5669
Country	:	US
Telephone Number	:	330-587-5587
Fax Number	:	330-587-5588

Authorized Official
Title or Position	:	OWNER
Name	:	KUN NAM
Credential	:	MD
Telephone Number	:	330-587-5587

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	01/29/2020

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Directions to “YOUR HOME COURT ADVANTAGE ” Practice Location

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