Provider Demographics
NPI:1568115764
Name:ADVANTAGE HEALTH CONNECTION
Entity Type:Organization
Organization Name:ADVANTAGE HEALTH CONNECTION
Other - Org Name:ADVANTAGE HEALTH CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:336-501-5417
Mailing Address - Street 1:806 GREEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7076
Mailing Address - Country:US
Mailing Address - Phone:336-890-6365
Mailing Address - Fax:336-890-6365
Practice Address - Street 1:1451 S ELM EUGENE ST STE 310
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27406-2200
Practice Address - Country:US
Practice Address - Phone:336-890-6365
Practice Address - Fax:336-890-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physicianGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNP3709OtherNP3709