Basic Information
| Provider Information | |||||||||
| NPI: | 1285715185 | ||||||||
| 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: | 4001 PIEDMONT PKWY | ||||||||
| Address2: | |||||||||
| City: | HIGH POINT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3368788824 | ||||||||
| FaxNumber: | 3368788883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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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 | 261QH0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Health Service | 251F00000X | N | Agencies | Home Infusion | 261QI0500X | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 333600000X | N | Suppliers | Pharmacy | 3336C0004X | 0214001277 | VA | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336H0001X | 05113 | NC | Y | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 1285715185 | 05 | VA | MEDICAID | BH1976159 | 01 | DEA | OTHER | 1285715185 | 05 | NC | MEDICAID | 7N5113 | 05 | SC | MEDICAID |