Provider Demographics
NPI:1346422540
Name:ADVANCED HEALTH RESOURCES INC
Entity Type:Organization
Organization Name:ADVANCED HEALTH RESOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
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:
Practice Address - Street 1:730 S SCALES ST
Practice Address - Street 2:SUITE B
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5335
Practice Address - Country:US
Practice Address - Phone:336-347-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302016GMedicaid