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General NPI Number Information
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NPI Number | 1427461292
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Entity Type | Organization
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Legal Business Name | AVANTARA PARK RIDGE LLC
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Dates
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Enumeration Date | 06/09/2014
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Last Update Date | 06/09/2014
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Provider Practice Location Address
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Address Line | 1601 N WESTERN AVE
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City | PARK RIDGE
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State | IL
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Zip | 60068-1233
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Country | US
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Telephone | 847-825-5531
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Fax | 847-316-6659
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Provider Business Mailing Address
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Address Line | 7040 N RIDGEWAY AVE
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City | LINCOLNWOOD
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State | IL
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Zip | 60712-2620
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Country | US
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Telephone | 847-825-5531
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Fax | 847-316-6659
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Authorized Official
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Title or Position | ATTORNEY
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Name | MS. FRANCES MEEHAN
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Credential |
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Telephone | 312-521-2467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | IL
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