Provider Demographics
NPI:1376524710
Name:CARE ADVANTAGE SKILLED-RICHMOND, LLC
Entity Type:Organization
Organization Name:CARE ADVANTAGE SKILLED-RICHMOND, LLC
Other - Org Name:CARE ADVANTAGE SKILLED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-560-5430
Mailing Address - Street 1:10043 MIDLOTHIAN TPKE FL 2
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4856
Mailing Address - Country:US
Mailing Address - Phone:804-560-5430
Mailing Address - Fax:804-560-5431
Practice Address - Street 1:10043 MIDLOTHIAN TPKE
Practice Address - Street 2:204
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-560-5439
Practice Address - Fax:804-560-5431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA497735251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVA010138205Medicaid
VA497594Medicare ID - Type UnspecifiedMEDICARE ID#