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General NPI Number Information
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NPI Number | 1790752251
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Entity Type | Organization
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Legal Business Name | ADVANCED HOME CARE INC
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 72 SAINT JOHNS PLACE RD
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City | SALEM
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State | VA
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Zip | 24153-5568
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Country | US
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Telephone | 540-389-8121
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Fax | 540-389-8128
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Provider Business Mailing Address
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Address Line | PO BOX 18049
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City | GREENSBORO
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State | NC
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Zip | 27419-8049
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Country | US
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Telephone | 336-878-8950
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Fax | 336-878-8853
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MIKE KALBAUGH
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Credential |
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Telephone | 336-878-8824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 0206008324
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0201003184
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0206008324
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0201003184
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0206008324
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License Number State | VA
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