1033164850 NPI number — ADVOCARE, LLC

Table of content: (NPI 1033164850)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033164850 NPI number — ADVOCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVOCARE, LLC
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:
6
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:
1033164850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 ROUTE 73 N STE 320
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-3426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-872-7055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 GROVE ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HADDONFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08033-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-354-2211
Provider Business Practice Location Address Fax Number:
856-354-6181
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCQUEARY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VP AND COO
Authorized Official Telephone Number:
856-872-7055

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0119164 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31D0911582 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".




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