Provider Demographics
NPI:1497413009
Name:ADVAITA HEALTH VENTURES LLC
Entity Type:Organization
Organization Name:ADVAITA HEALTH VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:EULAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:828-228-6148
Mailing Address - Street 1:6124 SAINT GILES ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7042
Mailing Address - Country:US
Mailing Address - Phone:828-228-6148
Mailing Address - Fax:
Practice Address - Street 1:6124 SAINT GILES ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-7042
Practice Address - Country:US
Practice Address - Phone:828-228-6148
Practice Address - Fax:984-204-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center