Healthcare Provider Details

I. General information

NPI: 1477968931
Provider Name (Legal Business Name): ADVANCED HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 EISENHOWER PKWY 5
MACON GA
31206-0805
US

IV. Provider business mailing address

PO BOX 18049
GREENSBORO NC
27419-8049
US

V. Phone/Fax

Practice location:
  • Phone: 478-785-6455
  • Fax: 800-311-7783
Mailing address:
  • Phone: 800-868-8822
  • Fax: 800-311-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberTO BE ISSUED
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberTO BE ISSUED
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberTO BE ISSUED
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberTO BE ADDED
License Number StateGA

VIII. Authorized Official

Name: MIKE KALBAUGH
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 336-878-8824