Organization
GRAND PRAIRIE ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK LAVERDIERE (OWNER)
(309) 837-1258
Entity
Organization
Contact information
Practice address
1307 MEADOWLARK LN, MACOMB, IL 61455-7508
(309) 833-5000
(309) 833-6410
Mailing address
1307 MEADOWLARK LN, MACOMB, IL 61455-7508
(309) 833-5000
(309) 833-6410
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
5102790
IL
Other
Enumeration date
04/18/2013
Last updated
04/18/2013
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