Provider Demographics
NPI:1033841788
Name:AVA HOMECARE
Entity Type:Organization
Organization Name:AVA HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTANT/PHLEBOTOMIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALTIERRA
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:928-502-1411
Mailing Address - Street 1:691 S EL PRADO RD
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2555
Mailing Address - Country:US
Mailing Address - Phone:928-502-1411
Mailing Address - Fax:
Practice Address - Street 1:691 S EL PRADO RD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2555
Practice Address - Country:US
Practice Address - Phone:928-502-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health