Provider Demographics
NPI:1619362530
Name:CARE ADVANTAGE - STAY AT HOME, LLC
Entity Type:Organization
Organization Name:CARE ADVANTAGE - STAY AT HOME, LLC
Other - Org Name:STAY AT HOME PERSONAL CARE CHRISTIANSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:757-708-2191
Mailing Address - Street 1:10041 MIDLOTHIAN TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-323-9667
Mailing Address - Fax:804-330-3156
Practice Address - Street 1:201 WHEATLAND CT
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1091
Practice Address - Country:US
Practice Address - Phone:540-808-1180
Practice Address - Fax:844-870-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-18565253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA01-67389722Medicaid
VA01-67390225Medicaid