Provider Demographics
NPI:1487374641
Name:ADVANCE HOME HEALTHCARE
Entity type:Organization
Organization Name:ADVANCE HOME HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-418-4001
Mailing Address - Street 1:1203 US HIGHWAY 98 STE 2A11
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-3902
Mailing Address - Country:US
Mailing Address - Phone:251-418-4001
Mailing Address - Fax:251-418-4002
Practice Address - Street 1:1203 US HIGHWAY 98 STE 2A11
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-3902
Practice Address - Country:US
Practice Address - Phone:251-418-4001
Practice Address - Fax:251-418-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No385H00000XRespite Care FacilityRespite Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child