Provider Demographics
NPI:1295103703
Name:ADVANCED ADVANTAGE HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:ADVANCED ADVANTAGE HOMECARE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/DIRECTOE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:IWE
Authorized Official - Last Name:NWAOKWU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:512-287-0444
Mailing Address - Street 1:3621 FRANKFORD RD
Mailing Address - Street 2:APT # 411
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6100
Mailing Address - Country:US
Mailing Address - Phone:512-287-0444
Mailing Address - Fax:214-731-6156
Practice Address - Street 1:3621 FRANKFORD RD
Practice Address - Street 2:APT # 411
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6100
Practice Address - Country:US
Practice Address - Phone:512-287-0444
Practice Address - Fax:214-731-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care