Provider Demographics
NPI:1699848135
Name:ADVANTAGE GROUP FOUNDATION, LTD
Entity Type:Organization
Organization Name:ADVANTAGE GROUP FOUNDATION, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KALEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-444-6400
Mailing Address - Street 1:422 TAG WAY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6288
Mailing Address - Country:US
Mailing Address - Phone:815-444-6400
Mailing Address - Fax:815-444-6816
Practice Address - Street 1:422 TAG WAY
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6288
Practice Address - Country:US
Practice Address - Phone:815-444-6400
Practice Address - Fax:815-444-6816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0834101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty