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NPI Code Detail

MEDICARE: AVENUE CARE CENTER

MEDICARE: AVENUE CARE CENTER
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
1314000000XSkilled Nursing Facility003340IL

General Provider Information

NPI Number : 1558406926
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVENUE CARE CENTER
Provider Business Mailing Address
First Line : 8320 SKOKIE BLVD
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2545
Country : US
Telephone Number : 847-329-1555
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S DREXEL BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4301
Country : US
Telephone Number : 773-285-0550
Fax Number :
Authorized Official
Title or Position : CONTROLLER
Name : JENNIE SHAN-MARTIN
Credential :
Telephone Number : 847-329-1555
Provider Enumeration Date : 02/21/2007
Last Update Date : 08/22/2020

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Directions to “AVENUE CARE CENTER ” Practice Location

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