Provider Demographics
NPI:1992278568
Name:AVONDALE CARE HOME
Entity type:Organization
Organization Name:AVONDALE CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUTHINEE
Authorized Official - Middle Name:AGCAOILI
Authorized Official - Last Name:LAONIYOMTHAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-767-0311
Mailing Address - Street 1:6215 E OWENS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1802
Mailing Address - Country:US
Mailing Address - Phone:702-778-2753
Mailing Address - Fax:702-778-2753
Practice Address - Street 1:6215 E OWENS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-1802
Practice Address - Country:US
Practice Address - Phone:702-778-2753
Practice Address - Fax:702-778-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home