Provider Demographics
NPI:1962728584
Name:AVONDALE CARE GROUP LLC
Entity type:Organization
Organization Name:AVONDALE CARE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-254-6255
Mailing Address - Street 1:505 8TH AVE RM 200
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 8TH AVE RM 803
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6598
Practice Address - Country:US
Practice Address - Phone:646-254-6255
Practice Address - Fax:212-971-4465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1625L 001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health