Organization
ADVANCED HOME CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE KALBAUGH (CREDENTIALING SPECIALIST)
(336) 878-8824
Entity
Organization
Contact information
Practice address
105 JACK WHITE DR, KINGSPORT, TN 37664
(423) 378-7330
(800) 311-7783
Mailing address
PO BOX 18049, GREENSBORO, NC 27419-8049
(336) 878-8950
(336) 878-8883
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0004X
Compounding Pharmacy
—
—
3336H0001X
Home Infusion Therapy Pharmacy
Primary
000002963
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215134309
—
VA
05
—
Q032329
—
TN
Enumeration date
07/02/2007
Last updated
03/07/2023
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