Provider Demographics
NPI:1962155317
Name:ADVANCED HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:ADVANCED HOME HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:SHADBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:770-654-2489
Mailing Address - Street 1:3390 OLD OAKS RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4084
Mailing Address - Country:US
Mailing Address - Phone:770-654-2489
Mailing Address - Fax:
Practice Address - Street 1:3390 OLD OAKS RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4084
Practice Address - Country:US
Practice Address - Phone:770-654-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1962155317Medicaid
GA1306429618OtherNPI