Provider Demographics
NPI:1871559245
Name:ADVANCED HEALTH CARE MANAGEMENT SERVICES, LLC
Entity type:Organization
Organization Name:ADVANCED HEALTH CARE MANAGEMENT SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:NOT APPLICABLE
Authorized Official - Phone:573-778-0020
Mailing Address - Street 1:PO BOX 989
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63902-0989
Mailing Address - Country:US
Mailing Address - Phone:573-663-2392
Mailing Address - Fax:573-663-7992
Practice Address - Street 1:350 E WALNUT ST
Practice Address - Street 2:STE 1
Practice Address - City:ELLINGTON
Practice Address - State:MO
Practice Address - Zip Code:63638-8098
Practice Address - Country:US
Practice Address - Phone:573-663-2392
Practice Address - Fax:573-663-7992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED HEALTH CARE MANAGEMENT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-25
Last Update Date:2013-07-30
Deactivation Date:2013-02-06
Deactivation Code:
Reactivation Date:2013-07-30
Provider Licenses
StateLicense IDTaxonomies
MO697-9HH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO267446Medicare Oscar/Certification