MEDICARE: THE AVENUE FAMILY NETWORK, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency
2	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1083042501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AVENUE FAMILY NETWORK, INC.

Provider Business Mailing Address
First Line	:	P.O. BOX 8789
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49023
Country	:	US
Telephone Number	:	269-925-1725
Fax Number	:	269-925-1730

Provider Business Practice Location Address
First Line	:	2450 M 139
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-6445
Country	:	US
Telephone Number	:	269-925-1725
Fax Number	:	269-925-1730

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOSEPH K. GOEPFRICH
Credential	:
Telephone Number	:	269-925-1725

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	04/21/2023

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