Provider Demographics
NPI:1306005863
Name:AVONLEA COTTAGE OF QUAD CITIES 2, LLC.
Entity Type:Organization
Organization Name:AVONLEA COTTAGE OF QUAD CITIES 2, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-492-7800
Mailing Address - Street 1:10501 W 84TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1643
Mailing Address - Country:US
Mailing Address - Phone:913-492-7800
Mailing Address - Fax:913-492-7801
Practice Address - Street 1:2025 1ST ST E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-3402
Practice Address - Country:US
Practice Address - Phone:309-756-2257
Practice Address - Fax:309-756-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5100141310400000X
IL5100133310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility