Provider Demographics
NPI:1265456875
Name:ADVOCARE, LLC
Entity type:Organization
Organization Name:ADVOCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT AND COO
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:
Practice Address - Street 1:420 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5210
Practice Address - Country:US
Practice Address - Phone:610-449-6200
Practice Address - Fax:610-449-0775
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVOCARE , LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101628997Medicaid
021601AOtherCLIA
021601AOtherCLIA