Provider Demographics
NPI:1538225313
Name:ADVANTAGE HEALTH SYSTEMS
Entity type:Organization
Organization Name:ADVANTAGE HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNDANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-433-0469
Mailing Address - Street 1:9663 TIERRA GRANDE ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4569
Mailing Address - Country:US
Mailing Address - Phone:858-433-0469
Mailing Address - Fax:858-433-0479
Practice Address - Street 1:9663 TIERRA GRANDE ST
Practice Address - Street 2:SUITE #101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4569
Practice Address - Country:US
Practice Address - Phone:858-433-0469
Practice Address - Fax:858-433-0479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000163251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHHA08355FMedicaid
CA550000163OtherCDPH LICENSE
CA058355Medicare Oscar/Certification