Provider Demographics
NPI:1124354097
Name:AVALON HOMECARE LLC
Entity type:Organization
Organization Name:AVALON HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:KIBE
Authorized Official - Last Name:NJOROGE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:978-328-2510
Mailing Address - Street 1:86 MIDDLESEX ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-1519
Mailing Address - Country:US
Mailing Address - Phone:978-328-2510
Mailing Address - Fax:978-349-6102
Practice Address - Street 1:86 MIDDLESEX ST
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-1519
Practice Address - Country:US
Practice Address - Phone:978-328-2510
Practice Address - Fax:978-349-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health