Provider Demographics
NPI:1740268614
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:336-878-8822
Mailing Address - Fax:336-878-8853
Practice Address - Street 1:4001 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9402
Practice Address - Country:US
Practice Address - Phone:336-878-8822
Practice Address - Fax:336-878-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-02
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05113251F00000X, 332BP3500X, 333600000X
NC332B00000X
NC00786332BC3200X, 332BX2000X
NC05333336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0244470001OtherNATIONAL SUPPLIER CLEARINGHOUSE
NC0494AOtherBCBSNC IV
NC3429669OtherNCPDP
NC1013981OtherUHC ACM
NC6800401Medicaid
NC7702497Medicaid
NC0347007Medicaid
NC153369400OtherBLACK LUNG
NC8295OtherPARTNERS
NC0486POtherBCBSNC DME