Healthcare Provider Details

I. General information

NPI: 1356531966
Provider Name (Legal Business Name): ADVANCED HOME CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 PLAZA RD STE 20
WISE VA
24293-4613
US

IV. Provider business mailing address

PO BOX 18049
GREENSBORO NC
27419-8049
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-6269
  • Fax: 800-311-7783
Mailing address:
  • Phone: 336-878-8950
  • Fax: 800-311-7783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberTO BE ISSUED
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License NumberTO BE ISSUED
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberTO BE ISSUED
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License NumberTO BE ISSUED
License Number StateVA

VIII. Authorized Official

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