1740268614 NPI number — ADVANCED HOME CARE, INC.

Table of content: (NPI 1740268614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740268614 NPI number — ADVANCED HOME CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED HOME CARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740268614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 18049
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27419-8049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-878-8822
Provider Business Mailing Address Fax Number:
336-878-8853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 PIEDMONT PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGH POINT
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27265-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-878-8822
Provider Business Practice Location Address Fax Number:
336-878-8853
Provider Enumeration Date:
01/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KALBAUGH
Authorized Official First Name:
MIKE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
336-878-8824

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  05113 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 00786 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 05113 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 00786 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 333600000X , with the licence number: 05113 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 0533 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0244470001 . This is a "NATIONAL SUPPLIER CLEARINGHOUSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0494A . This is a "BCBSNC IV" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3429669 . This is a "NCPDP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1013981 . This is a "UHC ACM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6800401 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7702497 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0347007 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 153369400 . This is a "BLACK LUNG" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8295 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0486P . This is a "BCBSNC DME" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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