Provider Demographics
NPI:1053551879
Name:ADVANTAGE HOME CARE, LLC
Entity type:Organization
Organization Name:ADVANTAGE HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIRCEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-235-1244
Mailing Address - Street 1:11510 W LANGFORD CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1426
Mailing Address - Country:US
Mailing Address - Phone:480-235-1244
Mailing Address - Fax:480-304-3100
Practice Address - Street 1:11510 W LANGFORD CT
Practice Address - Street 2:
Practice Address - City:YOUNGTOWN
Practice Address - State:AZ
Practice Address - Zip Code:85363-1426
Practice Address - Country:US
Practice Address - Phone:480-235-1244
Practice Address - Fax:480-304-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZALH-7015310400000X
AZALH7346H311ZA0620X
AZ410906343900000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108669OtherBRIDGEWAY HEALTH SOLUTIONS
AZ410906OtherAHCCCS
AZ098867OtherSCAN HEALTH PLAN