Provider Demographics
NPI:1104118975
Name:AVANTI HOME HEALTH OF PALM BEACH CORP
Entity type:Organization
Organization Name:AVANTI HOME HEALTH OF PALM BEACH CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CONKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-733-1390
Mailing Address - Street 1:1015 GATEWAY BLVD STE 502
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8347
Mailing Address - Country:US
Mailing Address - Phone:561-733-1390
Mailing Address - Fax:561-739-9456
Practice Address - Street 1:1015 GATEWAY BLVD STE 502
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8347
Practice Address - Country:US
Practice Address - Phone:561-733-1390
Practice Address - Fax:561-739-9456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL299993913251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113570300Medicaid