Healthcare Provider Details

I. General information

NPI: 1720377138
Provider Name (Legal Business Name): ADVANCED HEALTH RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10940 RAVEN RIDGE RD STE 210
RALEIGH NC
27614-6611
US

IV. Provider business mailing address

10940 RAVEN RIDGE RD STE 210
RALEIGH NC
27614-6611
US

V. Phone/Fax

Practice location:
  • Phone: 919-465-3277
  • Fax: 919-465-3222
Mailing address:
  • Phone: 919-465-3277
  • Fax: 919-465-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY S. JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-465-3277