Healthcare Provider Details

I. General information

NPI: 1790752251
Provider Name (Legal Business Name): ADVANCED HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 SAINT JOHNS PLACE RD
SALEM VA
24153-5568
US

IV. Provider business mailing address

PO BOX 18049
GREENSBORO NC
27419-8049
US

V. Phone/Fax

Practice location:
  • Phone: 540-389-8121
  • Fax: 540-389-8128
Mailing address:
  • Phone: 336-878-8950
  • Fax: 336-878-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0206008324
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number0206008324
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0201003184
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0206008324
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201003184
License Number StateVA

VIII. Authorized Official

Name: MIKE KALBAUGH
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 336-878-8824