Provider Demographics
NPI:1891460325
Name:AVISTAR HOME HEALTH AGENCY
Entity type:Organization
Organization Name:AVISTAR HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:EFESOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-430-0996
Mailing Address - Street 1:1517 CAYMUS CT
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3254
Mailing Address - Country:US
Mailing Address - Phone:214-430-0996
Mailing Address - Fax:833-414-0604
Practice Address - Street 1:2201 SPINKS RD STE 133
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4451
Practice Address - Country:US
Practice Address - Phone:214-430-0996
Practice Address - Fax:833-414-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-16
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty