MEDICARE: ADVANTAGE PRIVATE HOME HEALTH SERVICES, 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	30211335	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30211335	OTHER	FL	AHCA LICENSE NUMBER

General Provider Information

NPI Number	:	1861658577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE PRIVATE HOME HEALTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	607 S MISSOURI AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-4735
Country	:	US
Telephone Number	:	863-603-9777
Fax Number	:	863-603-9779

Provider Business Practice Location Address
First Line	:	607 S MISSOURI AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-4735
Country	:	US
Telephone Number	:	863-603-9777
Fax Number	:	863-603-9779

Authorized Official
Title or Position	:	CEO
Name	:	MRS. MARGALINE LAZARRE
Credential	:	RN
Telephone Number	:	863-603-9777

Provider Enumeration Date	:	08/01/2008
Last Update Date	:	08/01/2008

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