Provider Demographics
NPI:1972688638
Name:TEAM NURSE, INC.
Entity Type:Organization
Organization Name:TEAM NURSE, INC.
Other - Org Name:CARE ADVANTAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-323-9464
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0776
Mailing Address - Country:US
Mailing Address - Phone:434-575-5200
Mailing Address - Fax:434-575-5204
Practice Address - Street 1:1087 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4506
Practice Address - Country:US
Practice Address - Phone:276-632-2252
Practice Address - Fax:276-632-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WC2100X, 251B00000X, 3747P1801X, 385H00000X
VAHCO-10175251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008751102OtherMEDICAID PRIVATE DUTY NURSING
VA00877164426Medicaid
VA008771642Medicaid
VA008703647Medicaid
VAHCO-09175OtherSTATE LICENSURE
VA1972688638OtherPRIVATE DUTY
VA0087036478Medicaid