Healthcare Provider Details

I. General information

NPI: 1811250541
Provider Name (Legal Business Name): ADVOCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 BLACK HORSE PIKE
GLENDORA NJ
08029-1308
US

IV. Provider business mailing address

PO BOX 71422
PHILADELPHIA PA
19176-1422
US

V. Phone/Fax

Practice location:
  • Phone: 856-939-2828
  • Fax: 856-939-5057
Mailing address:
  • Phone: 856-872-7055
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES MCQUEARY SR.
Title or Position: CEO
Credential:
Phone: 856-782-3300