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General NPI Number Information
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NPI Number | 1629258181
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Entity Type | Organization
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Legal Business Name | ADVANTAGE CARE INC.
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1129 N MAIN ST
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2547
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Country | US
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Telephone | 434-572-8272
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Fax | 434-572-8503
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Provider Business Mailing Address
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Address Line | 1129 N MAIN ST
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City | SOUTH BOSTON
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State | VA
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Zip | 24592-2547
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Country | US
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Telephone | 434-572-8272
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Fax | 434-572-8503
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAROL WALDIE
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Credential |
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Telephone | 434-572-8272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0101021765
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License Number State | VA
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