Provider Demographics
NPI:1942936067
Name:1ST ADVANTAGE HEALTHCARE INCORPORATED
Entity Type:Organization
Organization Name:1ST ADVANTAGE HEALTHCARE INCORPORATED
Other - Org Name:1ST ADVANTAGE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:CABANLIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-518-7268
Mailing Address - Street 1:2720 S RIVER RD STE 231
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4106
Mailing Address - Country:US
Mailing Address - Phone:224-500-3986
Mailing Address - Fax:224-347-1236
Practice Address - Street 1:2720 S RIVER RD STE 231
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-4106
Practice Address - Country:US
Practice Address - Phone:224-500-3986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1012146OtherIDPH