Provider Demographics
NPI:1912716705
Name:3RD AND INDIAN SCHOOL ASSISTED LIVING FACILITY, LLC
Entity type:Organization
Organization Name:3RD AND INDIAN SCHOOL ASSISTED LIVING FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JO ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEAVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-620-9874
Mailing Address - Street 1:121 W WACKER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1781
Mailing Address - Country:US
Mailing Address - Phone:217-620-9874
Mailing Address - Fax:
Practice Address - Street 1:4000 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-1285
Practice Address - Country:US
Practice Address - Phone:217-620-9874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility