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?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0499Medicaid