Provider Demographics
NPI:1093023608
Name:AYADAWAY HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AYADAWAY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED RESPIRATORY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ELTON
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:HALLS
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:904-329-1990
Mailing Address - Street 1:12225 HERON COVE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8095
Mailing Address - Country:US
Mailing Address - Phone:904-329-1990
Mailing Address - Fax:904-329-1990
Practice Address - Street 1:12225 HERON COVE CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8095
Practice Address - Country:US
Practice Address - Phone:904-329-1990
Practice Address - Fax:904-329-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL10000091096332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies