Organization
AV360 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETSY KOSTKA (DIRECTOR OF OPERATIONS)
(224) 520-0390
Entity
Organization
Contact information
Practice address
2140 LAKE COOK RD, ALGONQUIN, IL 60102-5447
(224) 333-0948
(224) 228-2822
Mailing address
2140 LAKE COOK RD, ALGONQUIN, IL 60102-5447
(224) 333-0948
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
10/15/2020
Last updated
01/11/2022
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