Provider Demographics
NPI:1710332184
Name:CARE ADVANTAGE, INC
Entity Type:Organization
Organization Name:CARE ADVANTAGE, INC
Other - Org Name:CARE ADVANTAGE FREDRICKSBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-323-9464
Mailing Address - Street 1:1901 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5101
Mailing Address - Country:US
Mailing Address - Phone:804-323-9464
Mailing Address - Fax:804-330-3156
Practice Address - Street 1:10041 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4815
Practice Address - Country:US
Practice Address - Phone:804-323-9464
Practice Address - Fax:804-330-3156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE ADVANTAGE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008773203Medicaid
VA008704112Medicaid