Provider Demographics
NPI:1538338769
Name:AVIS FOSTER CARE HOME,INC.
Entity type:Organization
Organization Name:AVIS FOSTER CARE HOME,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:386-586-3030
Mailing Address - Street 1:4 SLUMBER MEADOW TRL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-5322
Mailing Address - Country:US
Mailing Address - Phone:386-586-3030
Mailing Address - Fax:386-586-7524
Practice Address - Street 1:4 SLUMBER MEADOW TRL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5322
Practice Address - Country:US
Practice Address - Phone:386-586-3030
Practice Address - Fax:386-586-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693285198Medicaid