Healthcare Provider Details

I. General information

NPI: 1285956813
Provider Name (Legal Business Name): AVENUE CARE NURSING AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 02/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S DREXEL BLVD
CHICAGO IL
60653-4301
US

IV. Provider business mailing address

4505 S DREXEL BLVD
CHICAGO IL
60653-4301
US

V. Phone/Fax

Practice location:
  • Phone: 773-285-0550
  • Fax: 773-285-5618
Mailing address:
  • Phone: 773-285-0550
  • Fax: 773-285-5618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0050732
License Number StateIL

VIII. Authorized Official

Name: JOE ZIMMERMAN
Title or Position: CEO
Credential:
Phone: 847-905-4000