Provider Demographics
NPI:1245604099
Name:ADVANTAGE HOME CARE AGENCY
Entity Type:Organization
Organization Name:ADVANTAGE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-604-7182
Mailing Address - Street 1:2216 W MEADOWVIEW RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3406
Mailing Address - Country:US
Mailing Address - Phone:919-604-7182
Mailing Address - Fax:
Practice Address - Street 1:2216 W MEADOWVIEW RD
Practice Address - Street 2:SUITE 120
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3406
Practice Address - Country:US
Practice Address - Phone:919-604-7182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health