Healthcare Provider Details

I. General information

NPI: 1093919771
Provider Name (Legal Business Name): AVON NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 23RD AVE
AVON IL
61415-9105
US

IV. Provider business mailing address

1790 23RD AVE
AVON IL
61415-9105
US

V. Phone/Fax

Practice location:
  • Phone: 309-465-3102
  • Fax:
Mailing address:
  • Phone: 309-465-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0006510
License Number StateIL

VIII. Authorized Official

Name: PHIL KRAMER
Title or Position: ADMINISTRATOR
Credential:
Phone: 309-465-3102