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General NPI Number Information
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NPI Number | 1881009983
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Entity Type | Organization
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Legal Business Name | 1ST ADVANTAGE HOME CARE INC
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Dates
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Enumeration Date | 06/26/2014
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 2103C OLD COUNTY RD
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City | POCAHONTAS
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State | AR
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Zip | 72455-4137
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Country | US
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Telephone | 870-609-1930
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Fax | 870-609-1936
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Provider Business Mailing Address
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Address Line | 2103C OLD COUNTY RD
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City | POCAHONTAS
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State | AR
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Zip | 72455-4137
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Country | US
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Telephone | 870-609-1930
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Fax | 870-609-1936
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER NICOLE CRISMON
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Credential | RN
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Telephone | 870-378-0529
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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