Provider Demographics
NPI:1225197072
Name:ADVANCE CARE LLC
Entity Type:Organization
Organization Name:ADVANCE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-897-9056
Mailing Address - Street 1:575 SOUTHLAKE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3095
Mailing Address - Country:US
Mailing Address - Phone:804-897-9056
Mailing Address - Fax:804-897-9058
Practice Address - Street 1:575 SOUTHLAKE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3095
Practice Address - Country:US
Practice Address - Phone:804-897-9056
Practice Address - Fax:804-897-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-07395251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA469339OtherJCAHO
VAHCO-07395OtherHOME CARE LICENSE NUMBER
VAHCO-07395OtherHOME CARE LICENSE NUMBER