Healthcare Provider Details

I. General information

NPI: 1285715185
Provider Name (Legal Business Name): ADVANCED HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 PIEDMONT PKWY
HIGH POINT NC
27265
US

IV. Provider business mailing address

PO BOX 18049
GREENSBORO NC
27419-8049
US

V. Phone/Fax

Practice location:
  • Phone: 336-878-8824
  • Fax: 336-878-8883
Mailing address:
  • Phone: 336-878-8824
  • Fax: 336-878-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number0214001277
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number05113
License Number StateNC

VIII. Authorized Official

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