Healthcare Provider Details

I. General information

NPI: 1568115764
Provider Name (Legal Business Name): ADVANTAGE HEALTH CONNECTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 S ELM EUGENE ST STE 310
GREENSBORO NC
27406-2200
US

IV. Provider business mailing address

806 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-7076
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-6365
  • Fax: 336-890-6365
Mailing address:
  • Phone: 336-890-6365
  • Fax: 336-890-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARLENE M SPARKS
Title or Position: DIRECTOR
Credential: REGISTERED NURSE
Phone: 336-501-5417