Provider Demographics
NPI:1124797246
Name:AVA BEHAVIORAL CARE LLC
Entity type:Organization
Organization Name:AVA BEHAVIORAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:AZUBIKE
Authorized Official - Last Name:AMOBI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:240-423-6528
Mailing Address - Street 1:9825 SAMANTHA SUZANNE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1507
Mailing Address - Country:US
Mailing Address - Phone:240-423-6528
Mailing Address - Fax:
Practice Address - Street 1:9825 SAMANTHA SUZANNE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1507
Practice Address - Country:US
Practice Address - Phone:240-423-6528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-11
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA-510-847-079-447OtherTEXAS DRIVER'S LICENSE