Provider Demographics
NPI:1215693205
Name:PARK AVENUE HOME HEALTH LLC
Entity type:Organization
Organization Name:PARK AVENUE HOME HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEKA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:718-877-8895
Mailing Address - Street 1:27045 E UNIVERSITY DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-2746
Mailing Address - Country:US
Mailing Address - Phone:214-597-9905
Mailing Address - Fax:214-307-8009
Practice Address - Street 1:27045 E UNIVERSITY DR STE 1C
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-2746
Practice Address - Country:US
Practice Address - Phone:214-597-9905
Practice Address - Fax:214-307-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion