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General NPI Number Information
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NPI Number | 1215250881
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Entity Type | Organization
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Legal Business Name | AVENUES TO INDEPENDENCE
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 515 BUSSE HWY
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City | PARK RIDGE
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State | IL
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Zip | 60068-3154
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Country | US
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Telephone | 847-292-0870
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Fax | 847-292-0873
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Provider Business Mailing Address
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Address Line | 515 BUSSE HWY
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City | PARK RIDGE
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State | IL
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Zip | 60068-3154
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Country | US
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Telephone | 847-292-0870
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Fax | 847-292-0873
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Authorized Official
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Title or Position | CEO
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Name | MR. ROBERT OKAZAKI
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Credential | CRC, LPC
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Telephone | 847-292-0870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | IL
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