Provider Demographics
NPI:1124531991
Name:ADVANCE HOME CARE & MEDICAL SERVICES, INC.
Entity type:Organization
Organization Name:ADVANCE HOME CARE & MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:EZEH
Authorized Official - Last Name:OKIYIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:770-572-9328
Mailing Address - Street 1:1109 GARRISON PLANTATION DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-3145
Mailing Address - Country:US
Mailing Address - Phone:770-572-9328
Mailing Address - Fax:404-445-8008
Practice Address - Street 1:1109 GARRISON PLANTATION DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-3145
Practice Address - Country:US
Practice Address - Phone:770-572-9328
Practice Address - Fax:404-445-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN075934164W00000X
GARN157280163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty