Provider Demographics
NPI:1346658002
Name:ANTELOPE VALLEY EPSDT & WAIVERS AGENCY, CORP
Entity type:Organization
Organization Name:ANTELOPE VALLEY EPSDT & WAIVERS AGENCY, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-952-9512
Mailing Address - Street 1:25379 WAYNE MILLS PL
Mailing Address - Street 2:#134
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1827
Mailing Address - Country:US
Mailing Address - Phone:661-952-9512
Mailing Address - Fax:
Practice Address - Street 1:1431 W ROSAMOND BLVD
Practice Address - Street 2:#14D
Practice Address - City:ROSAMOND
Practice Address - State:CA
Practice Address - Zip Code:93560-7428
Practice Address - Country:US
Practice Address - Phone:661-952-9512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child