Basic Information
| Provider Information | |||||||||
| NPI: | 1477968931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED HOME CARE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 18049 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274198049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008688822 | ||||||||
| FaxNumber: | 8003117783 | ||||||||
| Practice Location | |||||||||
| Address1: | 3780 EISENHOWER PKWY | ||||||||
| Address2: | 5 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312060805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787856455 | ||||||||
| FaxNumber: | 8003117783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 11/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | KALBAUGH | ||||||||
| AuthorizedOfficialFirstName: | MIKE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 3368788824 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | TO BE ISSUED | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | TO BE ISSUED | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 3336H0001X | TO BE ADDED | GA | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 332B00000X | TO BE ISSUED | GA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 003161782A | 05 | GA | MEDICAID |