Provider Demographics
NPI:1316938772
Name:ADVANTAGE HOME HEALTH & HOSPICE
Entity type:Organization
Organization Name:ADVANTAGE HOME HEALTH & HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-647-0653
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-0594
Mailing Address - Country:US
Mailing Address - Phone:918-647-0653
Mailing Address - Fax:918-647-0654
Practice Address - Street 1:20775 292ND ST
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-7223
Practice Address - Country:US
Practice Address - Phone:918-647-0653
Practice Address - Fax:918-647-0654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7772251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377671Medicare PIN