Provider Demographics
NPI:1093919771
Name:AVON NURSING HOME, INC.
Entity Type:Organization
Organization Name:AVON NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-465-3102
Mailing Address - Street 1:1790 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IL
Mailing Address - Zip Code:61415-9105
Mailing Address - Country:US
Mailing Address - Phone:309-465-3102
Mailing Address - Fax:
Practice Address - Street 1:1790 23RD AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IL
Practice Address - Zip Code:61415-9105
Practice Address - Country:US
Practice Address - Phone:309-465-3102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0006510313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid