Provider Demographics
NPI:1073985370
Name:AVIA PREMIER CARE, LLC
Entity Type:Organization
Organization Name:AVIA PREMIER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-215-9170
Mailing Address - Street 1:2126 VALRICO HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-6778
Mailing Address - Country:US
Mailing Address - Phone:813-215-9170
Mailing Address - Fax:
Practice Address - Street 1:2126 VALRICO HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-6778
Practice Address - Country:US
Practice Address - Phone:813-215-9170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services