| NPI | 1902462211 |
|---|---|
| Doing Business As | AVANTARA IPSWICH |
| Entity Type | Organization |
| Authorized Contact | MENACHEM SHABAT COO/Principal 847-679-9797 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2019-05-13 |