Healthcare Provider Details

I. General information

NPI: 1629258181
Provider Name (Legal Business Name): ADVANTAGE CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1129 N MAIN ST
SOUTH BOSTON VA
24592-2547
US

IV. Provider business mailing address

1129 N MAIN ST
SOUTH BOSTON VA
24592-2547
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8272
  • Fax: 434-572-8503
Mailing address:
  • Phone: 434-572-8272
  • Fax: 434-572-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0101021765
License Number StateVA

VIII. Authorized Official

Name: CAROL WALDIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 434-572-8272