Provider Demographics
NPI: | 1255507422 |
---|---|
Name: | ADVANTAGE HEALTH SYSTEMS |
Entity Type: | Organization |
Organization Name: | ADVANTAGE HEALTH SYSTEMS |
Other - Org Name: | CAREPRO MEDICAL ONE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | VALERIE |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | AIKEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 803-758-4000 |
Mailing Address - Street 1: | 1101 ELMWOOD AVE |
Mailing Address - Street 2: | SUITE G |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29201-2172 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-758-4000 |
Mailing Address - Fax: | 803-758-4001 |
Practice Address - Street 1: | 1101 ELMWOOD AVE |
Practice Address - Street 2: | SUITE G |
Practice Address - City: | COLUMBIA |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29201-2172 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-758-4000 |
Practice Address - Fax: | 803-758-4001 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-05-07 |
Last Update Date: | 2008-05-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251J00000X | Agencies | Nursing Care |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | EX0499 | Medicaid |