Provider Demographics
NPI:1720377138
Name:ADVANCED HEALTH RESOURCES
Entity Type:Organization
Organization Name:ADVANCED HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-465-3277
Mailing Address - Street 1:10940 RAVEN RIDGE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6611
Mailing Address - Country:US
Mailing Address - Phone:919-465-3277
Mailing Address - Fax:919-465-3222
Practice Address - Street 1:10940 RAVEN RIDGE RD STE 210
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6611
Practice Address - Country:US
Practice Address - Phone:919-465-3277
Practice Address - Fax:919-465-3222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3419122Medicaid