Provider Demographics
NPI:1609045897
Name:ALVIN EADES CENTER, INC.
Entity Type:Organization
Organization Name:ALVIN EADES CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-245-9898
Mailing Address - Street 1:905 W SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3117
Mailing Address - Country:US
Mailing Address - Phone:217-245-9898
Mailing Address - Fax:217-243-7966
Practice Address - Street 1:1000A W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3117
Practice Address - Country:US
Practice Address - Phone:217-245-9898
Practice Address - Fax:217-243-7966
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALVIN EADES CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0040220315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1710432968Medicaid