- Enrollment id
- O20230421002276
- Enrollment state
- IL
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1942936067
- Multiple npi flag
- N
- Ccn
- 148410
- Associate id
- 3072978287
- Organization name
- 1ST ADVANTAGE HEALTHCARE INCORPORATED
- Doing business as name
- 1ST ADVANTAGE HOME HEALTH AGENCY
- Incorporation date
- 2022-01-11
- Incorporation state
- IL
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 2720 S RIVER RD
- Address line 2
- STE 231
- City
- DES PLAINES
- State
- IL
- Zip code
- 600184153
- Practice location type
- HHA BRANCH