Contract Details
Ancillary Care Services
Facility name
Homecare Advantage
Provider ID
P000003865
NPI
1124128244
Tax ID
141858113
Effective Date
4/1/2012
Last Updated
10/21/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
185 East McCallister Drive
Terre Haute, IN 47802
United States
County
Vigo
Phone
8122344602 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address