Healthcare Provider Details

I. General information

NPI: 1326550658
Provider Name (Legal Business Name): CARE ADVANTAGE-NORTH CAROLINA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 AVENT FERRY RD STE 103
RALEIGH NC
27606
US

IV. Provider business mailing address

10041 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-4815
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-9464
  • Fax:
Mailing address:
  • Phone: 804-323-9464
  • Fax: 804-331-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNC

VIII. Authorized Official

Name: MR. TIMOTHY HANOLD
Title or Position: CEO
Credential:
Phone: 804-323-9464