Organization
DOWNERS GROVE SUPPORTIVE LIVING LLC
Active
Other names
Lacey Creek Supportive LIving
Organization subpart
No
Provider details
NPI number
Authorized official
JOELLEN BLEAVINS (PRESIDENT OF MANAGEMENT AGENT)
(815) 935-1992
Entity
Organization
Contact information
Practice address
4200 LACEY ROAD, DOWNERS GROVE, IL 60515
(630) 964-7720
(630) 964-4229
Mailing address
4200 LACEY ROAD, DOWNERS GROVE, IL 60515
(630) 964-7720
(630) 964-4229
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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