Basic Information
| Provider Information | |||||||||
| NPI: | 1043649635 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVANCED HOME CARE INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED HOME CARE INC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18049 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274198049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368788824 | ||||||||
| FaxNumber: | 3368788883 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 EBCO CIR STE 102 | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22980 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5409323000 | ||||||||
| FaxNumber: | 8002777455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | KALBAUGH | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3368788824 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 333600000X | N | Suppliers | Pharmacy | 3336H0001X | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336C0004X | 0201002399 | VA | Y | Suppliers | Pharmacy | Compounding Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | MR0551988 | 01 | WV | DRUG MANUFACTURER CONTROLLED SUBSTANCE PERMIT | OTHER | FA7356036 | 01 | DEA | OTHER |