Healthcare Provider Details

I. General information

NPI: 1003398264
Provider Name (Legal Business Name): ADVANCE CARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 SADLER PL # 2550
GLEN ALLEN VA
23060-6122
US

IV. Provider business mailing address

PO BOX 2550
GLEN ALLEN VA
23058-2550
US

V. Phone/Fax

Practice location:
  • Phone: 804-334-3802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NIRAJ PATEL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 804-608-6012