Organization
ADVANTAGE HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL DAWN COULTER (PARTNER)
(304) 587-9994
Entity
Organization
Contact information
Practice address
151 MAIN STREET, CLAY, WV 25043
(304) 587-9992
(304) 587-9993
Mailing address
PO BOX 835, CLAY, WV 25043-0835
(304) 587-9992
(304) 587-9993
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
22475308
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810019776
—
WV
Enumeration date
12/04/2014
Last updated
12/04/2014
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