Provider Demographics
NPI:1861212185
Name:ADVANCED SPECIALIZED KARE LLC
Entity type:Organization
Organization Name:ADVANCED SPECIALIZED KARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:SHATEARANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-543-8974
Mailing Address - Street 1:200 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COLLINS
Mailing Address - State:MS
Mailing Address - Zip Code:39428-6188
Mailing Address - Country:US
Mailing Address - Phone:601-543-8974
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:COLLINS
Practice Address - State:MS
Practice Address - Zip Code:39428-6188
Practice Address - Country:US
Practice Address - Phone:601-543-8974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion