Healthcare Provider Details

I. General information

NPI: 1124510748
Provider Name (Legal Business Name): CARE ADVANTAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2018
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 BREEZEPORT WAY STE 600
SUFFOLK VA
23435-3756
US

IV. Provider business mailing address

10041 MIDLOTHIAN TPKE
NORTH CHESTERFIELD VA
23235-4815
US

V. Phone/Fax

Practice location:
  • Phone: 757-325-9716
  • Fax: 757-384-1552
Mailing address:
  • Phone: 804-323-9464
  • Fax: 804-330-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY ROYSTER
Title or Position: SENIOR MANAGER OF ACCOUNTING
Credential:
Phone: 804-323-9464