Provider Demographics
NPI:1881009983
Name:1ST ADVANTAGE HOME CARE INC
Entity Type:Organization
Organization Name:1ST ADVANTAGE HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CRISMON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:870-378-0529
Mailing Address - Street 1:2103C OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-4137
Mailing Address - Country:US
Mailing Address - Phone:870-609-1930
Mailing Address - Fax:870-609-1936
Practice Address - Street 1:2103C OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-4137
Practice Address - Country:US
Practice Address - Phone:870-609-1930
Practice Address - Fax:870-609-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care