Provider Demographics
NPI:1861727034
Name:HEALTHCARE ADVANTAGE LLC
Entity type:Organization
Organization Name:HEALTHCARE ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:601-420-0141
Mailing Address - Street 1:PO BOX 1995
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-1995
Mailing Address - Country:US
Mailing Address - Phone:601-695-1919
Mailing Address - Fax:601-420-5299
Practice Address - Street 1:254 INGLESIDE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9524
Practice Address - Country:US
Practice Address - Phone:601-695-1919
Practice Address - Fax:601-420-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000000OtherTO BE ASSIGNED