Provider Demographics
NPI:1083042501
Name:THE AVENUE FAMILY NETWORK, INC.
Entity Type:Organization
Organization Name:THE AVENUE FAMILY NETWORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GOEPFRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-925-1725
Mailing Address - Street 1:P.O. BOX 8789
Mailing Address - Street 2:
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49023
Mailing Address - Country:US
Mailing Address - Phone:269-925-1725
Mailing Address - Fax:269-925-1730
Practice Address - Street 1:2450 M 139
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-6445
Practice Address - Country:US
Practice Address - Phone:269-925-1725
Practice Address - Fax:269-925-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health