Provider Demographics
NPI: | 1760957534 |
---|---|
Name: | ADVOCARE, LLC |
Entity Type: | Organization |
Organization Name: | ADVOCARE, LLC |
Other - Org Name: | ADVOCARE PEDIATRIC HEALTH |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | CHARLES |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCQUEARY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 856-872-7055 |
Mailing Address - Street 1: | 401 ROUTE 73 N STE 320 |
Mailing Address - Street 2: | |
Mailing Address - City: | MARLTON |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08053-3426 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-872-7055 |
Mailing Address - Fax: | 732-780-6968 |
Practice Address - Street 1: | 470 STILLWELLS CORNER RD |
Practice Address - Street 2: | |
Practice Address - City: | FREEHOLD |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 07728-2969 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-780-3333 |
Practice Address - Fax: | 732-780-6968 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | ADVOCARE, LLC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2018-10-09 |
Last Update Date: | 2021-11-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |