Basic Information
| Provider Information | |||||||||
| NPI: | 1639415425 | ||||||||
| 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: | 5901 GOSHEN SPRINGS RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704496898 | ||||||||
| FaxNumber: | 8003117783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2012 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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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 | 251F00000X | PHRE010124 | GA | N | Agencies | Home Infusion | 332BP3500X | PHRE010124 | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | PHWH003765 | GA | N | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies | 333600000X | PHRE010124 | GA | N | Suppliers | Pharmacy | 3336H0001X | PHRE010124 | GA | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 332B00000X | PHRE010124 | GA | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 975916385A | 05 | GA | MEDICAID |