LACEY CREEK SUPPORTIVE LIVING
NPI 1073069209
Assisted Living Facility in Downers Grove, IL

Active since August 28, 2016
4200 LACEY ROAD, DOWNERS GROVE, IL 60515(630) 964-7720(630) 964-4229 Get Directions Write a Review

NPPES record last updated: August 28, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Lacey Creek Supportive Living NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LACEY CREEK SUPPORTIVE LIVING (NPI 1073069209) is a healthcare organization registered as an assisted living facility in Downers Grove, Illinois and active in the NPI registry since August 2016. The organization lists Joellen Bleavins, President Of Management Agent, as its authorized official.

NPPES Registry Identity

NPI1073069209
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameDOWNERS GROVE SUPPORTIVE LIVING LLC
Location Address4200 LACEY ROADDowners Grove, IL 60515
Mailing Address4200 Lacey RoadDowners Grove, IL 60515 · (630) 964-7720 · Fax (630) 964-4229
Fax(630) 964-4229
Organization SubpartNo
Authorized OfficialJoellen BleavinsPresident Of Management Agent · (815) 935-1992
Enumeration DateAugust 28, 2016
NPI 1073069209 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

4200 LACEY ROAD, Downers Grove, IL 60515

Other Names 1

Doing Business AsLacey Creek Supportive Living

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Downers Grove Supportive Living LLC's NPI number?

The NPI number for Downers Grove Supportive Living LLC is 1073069209. It was assigned to this organization in the NPPES registry on August 28, 2016. The provider is doing business as Lacey Creek Supportive Living.

Where is Downers Grove Supportive Living LLC located?

Downers Grove Supportive Living LLC is located at 4200 Lacey Road, Downers Grove, IL 60515. The listed phone number is (630) 964-7720.

What is Downers Grove Supportive Living LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

When was this NPI record last updated?

The NPPES record for Downers Grove Supportive Living LLC was last updated on August 28, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.