Provider Demographics
NPI:1619172236
Name:ADVANCED HOME CARE, INC.
Entity Type:Organization
Organization Name:ADVANCED HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-878-8824
Mailing Address - Street 1:PO BOX 18049
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-8049
Mailing Address - Country:US
Mailing Address - Phone:336-878-8950
Mailing Address - Fax:800-311-7783
Practice Address - Street 1:105 JACK WHITE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2364
Practice Address - Country:US
Practice Address - Phone:423-230-8485
Practice Address - Fax:800-311-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN332B00000X, 332BC3200X, 332BN1400X, 332BX2000X
TN0000002963332BP3500X, 333600000X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4153574OtherBCBSTN IV
VA300795OtherANTHEM DME
TN4153575OtherBCBSTN DME
VA301489OtherANTHEM IV
VA300795OtherANTHEM DME