Provider Demographics
NPI:1003382474
Name:AVISA HOME CARE, INC.
Entity Type:Organization
Organization Name:AVISA HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-574-2234
Mailing Address - Street 1:19146 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1101
Mailing Address - Country:US
Mailing Address - Phone:310-574-2234
Mailing Address - Fax:310-354-2601
Practice Address - Street 1:19146 VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1101
Practice Address - Country:US
Practice Address - Phone:310-574-2234
Practice Address - Fax:310-354-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care