1053780668 NPI number — CARE ADVANTAGE INC.

Table of content: (NPI 1053780668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053780668 NPI number — CARE ADVANTAGE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE ADVANTAGE 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:
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:
1053780668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10041 MIDLOTHIAN TPKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23235-4815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-323-9464
Provider Business Mailing Address Fax Number:
804-330-3156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 LYNNHAVEN PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-7335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-632-4436
Provider Business Practice Location Address Fax Number:
757-632-4437
Provider Enumeration Date:
09/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSTON
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
804-323-9464

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: UNKNOWN , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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