Provider Demographics
NPI:1447367800
Name:ADVANTA HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:ADVANTA HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSHEV
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:847-504-0888
Mailing Address - Street 1:550 W FRONTAGE RD STE 3700
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1221
Mailing Address - Country:US
Mailing Address - Phone:847-504-0888
Mailing Address - Fax:847-504-0887
Practice Address - Street 1:550 W FRONTAGE RD STE 3700
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1221
Practice Address - Country:US
Practice Address - Phone:847-504-0888
Practice Address - Fax:847-504-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010489251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147887Medicare Oscar/Certification