Provider Demographics
NPI:1760619571
Name:APN FAMILY CARE
Entity Type:Organization
Organization Name:APN FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BEAUDOIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:NP
Authorized Official - Phone:708-293-8800
Mailing Address - Street 1:13303 S RIDGELAND AVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13303 S RIDGELAND AVE
Practice Address - Street 2:UNIT C
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1815
Practice Address - Country:US
Practice Address - Phone:708-293-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000346261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care