Basic Information
| Provider Information | |||||||||
| NPI: | 1578077731 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROOKS HOME CARE ADVANTAGE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6676 CORPORATE CENTER PKWY STE 104 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322160108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9047221515 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3424 SAINT JOHNS AVE | ||||||||
| Address2: | |||||||||
| City: | PALATKA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321774020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3863254567 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2017 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | BAER | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9043457473 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BROOKS HOME CARE ADVANTAGE, INC. | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.