Provider Demographics
NPI:1841911526
Name:AVERY'S HOUSE LLC
Entity type:Organization
Organization Name:AVERY'S HOUSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-200-8556
Mailing Address - Street 1:11445 E VIA LINDA STE 2-617
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2655
Mailing Address - Country:US
Mailing Address - Phone:203-200-8556
Mailing Address - Fax:
Practice Address - Street 1:11624 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5111
Practice Address - Country:US
Practice Address - Phone:203-200-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVERY'S HOUSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-09
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7992OtherSTATE LICENSE