Healthcare Provider Details

I. General information

NPI: 1417347345
Provider Name (Legal Business Name): CARE ADVANTAGE - STAY AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2015
Last Update Date: 05/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 RIVER WALK PKWY
CHESAPEAKE VA
23320-6819
US

IV. Provider business mailing address

10041 MIDLOTHIAN TURNPIKE
NORTH CHESTERFIELD VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 757-392-1001
  • Fax: 844-870-4775
Mailing address:
  • Phone: 804-323-9667
  • Fax: 804-330-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHCO-13745
License Number StateVA

VIII. Authorized Official

Name: BRANDI SMITH
Title or Position: SENIOR ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 757-708-2191