Provider Demographics
NPI:1689714875
Name:ADVANTICA DC-NOVA, LLC
Entity Type:Organization
Organization Name:ADVANTICA DC-NOVA, LLC
Other - Org Name:ADVANTICA EYECARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-425-2323
Mailing Address - Street 1:3290 PINE ORCHARD LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2374
Mailing Address - Country:US
Mailing Address - Phone:866-425-2323
Mailing Address - Fax:
Practice Address - Street 1:3290 PINE ORCHARD LN
Practice Address - Street 2:SUITE D
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2374
Practice Address - Country:US
Practice Address - Phone:866-425-2323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization