Provider Demographics
NPI:1669155008
Name:ADVANCED MEDIAID LLC
Entity type:Organization
Organization Name:ADVANCED MEDIAID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIVIDH
Authorized Official - Middle Name:
Authorized Official - Last Name:TALWAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-859-0673
Mailing Address - Street 1:8602 SPRINGWATER DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1799
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8602 SPRINGWATER DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-1799
Practice Address - Country:US
Practice Address - Phone:516-547-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health