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General NPI Number Information
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NPI Number | 1396558805
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Entity Type | Organization
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Legal Business Name | AVONDALE VAN BUREN ALF, LLC
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 295 E VAN BUREN ST
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City | AVONDALE
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State | AZ
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Zip | 85323-1419
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Country | US
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Telephone | 602-603-8200
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Fax |
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Provider Business Mailing Address
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Address Line | 121 W WACKER DR STE 400
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City | CHICAGO
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State | IL
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Zip | 60601-1781
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Country | US
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Telephone | 217-620-9874
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | JO ELLEN BLEAVINS
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Credential |
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Telephone | 217-620-9874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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