Provider Demographics
NPI:1790752251
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:336-878-8853
Practice Address - Street 1:72 SAINT JOHNS PLACE RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5568
Practice Address - Country:US
Practice Address - Phone:540-389-8121
Practice Address - Fax:540-389-8128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206008324332B00000X, 332BC3200X, 332BX2000X
VA0201003184332BP3500X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010115591Medicaid
VA168466OtherANTHEM IV
VA1013981OtherUHC ACM
VA432916OtherANTHEM DME
VA010115566Medicaid
VA0244470012Medicare NSC