Basic Information
| Provider Information | |||||||||
| NPI: | 1619172236 | ||||||||
| 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: | 3368788950 | ||||||||
| FaxNumber: | 8003117783 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 JACK WHITE DR | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376642364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232308485 | ||||||||
| FaxNumber: | 8003117783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 07/24/2017 | ||||||||
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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 | 332BC3200X | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332BN1400X | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Nursing Facility Supplies | 332BP3500X | 0000002963 | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | TN | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 333600000X | 0000002963 | TN | N | Suppliers | Pharmacy | 3336H0001X | 0000002963 | TN | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 332B00000X | TN | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 4153574 | 01 | TN | BCBSTN IV | OTHER | 300795 | 01 | VA | ANTHEM DME | OTHER | 4153575 | 01 | TN | BCBSTN DME | OTHER | 301489 | 01 | VA | ANTHEM IV | OTHER |