1104948439 NPI number — HOMECARE ADVANTAGE INC.

Table of content: (NPI 1104948439)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104948439 NPI number — HOMECARE ADVANTAGE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMECARE 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:
HOMECARE ADVANTAGE
Provider Other Organization Name Type Code:
3
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:
1104948439
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 BURNSIDE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02910-1149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-781-3400
Provider Business Mailing Address Fax Number:
401-781-3401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 BURNSIDE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02910-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-781-3400
Provider Business Practice Location Address Fax Number:
401-781-3401
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RILEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
401-781-3400

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HNC02285 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251J00000X , with the licence number: HNC02285 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: HC23272 . This is a "RI MEDICAL ASSISTANCE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 27651 . This is a "RI NEIGHBORHOOD HEALTH" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: HC12305 . This is a "RI MEDICAL ASSISTANCE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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