Provider Demographics
NPI:1255754651
Name:FIRST ADVANTAGE HOMECARE LLC
Entity type:Organization
Organization Name:FIRST ADVANTAGE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:PORTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-829-1278
Mailing Address - Street 1:1120 HICKS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-9401
Mailing Address - Country:US
Mailing Address - Phone:513-829-1278
Mailing Address - Fax:513-829-1412
Practice Address - Street 1:1120 HICKS BLVD SUITE 100
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014
Practice Address - Country:US
Practice Address - Phone:513-829-1278
Practice Address - Fax:513-829-1412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health