Healthcare Provider Details

I. General information

NPI: 1558271213
Provider Name (Legal Business Name): ADVOCARE , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BALA AVE STE 102
BALA CYNWYD PA
19004-3214
US

IV. Provider business mailing address

401 ROUTE 73 N BLDG 10
MARLTON NJ
08053-3425
US

V. Phone/Fax

Practice location:
  • Phone: 215-452-0304
  • Fax: 215-452-0311
Mailing address:
  • Phone: 856-872-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DEWAYNE HIEBERT
Title or Position: CHIEF OF PAYOR RELATIONS
Credential:
Phone: 856-872-7055