Provider Demographics
NPI:1447514633
Name:ADVANTAGE LLC
Entity type:Organization
Organization Name:ADVANTAGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARRUTHERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-375-8917
Mailing Address - Street 1:1991 S DOE CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-8518
Mailing Address - Country:US
Mailing Address - Phone:208-375-8917
Mailing Address - Fax:208-375-8917
Practice Address - Street 1:1991 S DOE CREEK WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-8518
Practice Address - Country:US
Practice Address - Phone:208-375-8917
Practice Address - Fax:208-375-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management