Provider Demographics
NPI:1972793990
Name:ADVANCED HEALTH RESOURCES
Entity Type:Organization
Organization Name:ADVANCED HEALTH RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-465-3277
Mailing Address - Street 1:1218 COPELAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6614
Mailing Address - Country:US
Mailing Address - Phone:919-465-3277
Mailing Address - Fax:919-465-3222
Practice Address - Street 1:N CARR MILL MALL
Practice Address - Street 2:200 N GREENSBORO ST STE C-6
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-1833
Practice Address - Country:US
Practice Address - Phone:919-960-2711
Practice Address - Fax:919-960-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006177Medicaid