Provider Demographics
NPI:1639415425
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 1:5901 GOSHEN SPRINGS RD
Practice Address - Street 2:SUITE G
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071
Practice Address - Country:US
Practice Address - Phone:770-449-6898
Practice Address - Fax:800-311-7783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-24
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE010124251F00000X, 332B00000X, 332BP3500X, 333600000X, 3336H0001X
GAPHWH003765332BX2000X
GA1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No251F00000XAgenciesHome Infusion
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA975916385AMedicaid
GA975916385AMedicaid