Provider Demographics
NPI:1124224829
Name:ADVANCED HEALTH RESOURCES
Entity Type:Organization
Organization Name:ADVANCED HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-465-3277
Mailing Address - Street 1:1218 COPELAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6614
Mailing Address - Country:US
Mailing Address - Phone:919-465-3277
Mailing Address - Fax:919-465-3222
Practice Address - Street 1:104 S ESTES DR
Practice Address - Street 2:SUITE 301D
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2866
Practice Address - Country:US
Practice Address - Phone:919-960-2711
Practice Address - Fax:919-960-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300311GMedicaid