Provider Demographics
NPI:1104178177
Name:ADVANCED HOME CARE, LLC
Entity type:Organization
Organization Name:ADVANCED HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-748-5757
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:NEW MADRID
Mailing Address - State:MO
Mailing Address - Zip Code:63869-0487
Mailing Address - Country:US
Mailing Address - Phone:573-748-5757
Mailing Address - Fax:573-748-5382
Practice Address - Street 1:39 VILLA SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:NEW MADRID
Practice Address - State:MO
Practice Address - Zip Code:63869-1230
Practice Address - Country:US
Practice Address - Phone:573-748-5757
Practice Address - Fax:573-748-5382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty