Provider Demographics
NPI:1487045761
Name:AVANCER HOMES, LLC
Entity Type:Organization
Organization Name:AVANCER HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-784-5146
Mailing Address - Street 1:350 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1361
Mailing Address - Country:US
Mailing Address - Phone:815-784-5146
Mailing Address - Fax:815-784-4673
Practice Address - Street 1:350 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1361
Practice Address - Country:US
Practice Address - Phone:815-784-5146
Practice Address - Fax:815-784-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities