Organization
ADVANTAGE II
Active
Other names
Advantage Choice
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE L MICHAEL (CEO)
(765) 281-6728
Entity
Organization
Contact information
Practice address
4021 N ROSEWOOD AVE, MUNCIE, IN 47304-1774
(765) 281-6728
(765) 284-1239
Mailing address
4021 N ROSEWOOD AVE, MUNCIE, IN 47304
(765) 281-6728
(765) 284-1239
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200506490
MEDICAID WAIVER
IN
Enumeration date
05/29/2007
Last updated
05/06/2014
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