MEDICARE: HOMECARE ADVANTAGE, INC.

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		WI

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	:	1710011010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOMECARE ADVANTAGE, INC.

Provider Business Mailing Address
First Line	:	1496 BELLEVUE ST
Second Line	:	SUITE 501
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4205
Country	:	US
Telephone Number	:	920-437-0496
Fax Number	:	920-437-8206

Provider Business Practice Location Address
First Line	:	1496 BELLEVUE ST
Second Line	:	SUITE 501
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4205
Country	:	US
Telephone Number	:	920-437-0496
Fax Number	:	920-437-8206

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ANN M ANDERSON
Credential	:	RN
Telephone Number	:	920-437-0496

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	05/04/2011

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