Provider Demographics
NPI:1114441573
Name:AVONDALE HME, INC.
Entity Type:Organization
Organization Name:AVONDALE HME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-543-4039
Mailing Address - Street 1:41689 ENTERPRISE CIR N STE 112
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41689 ENTERPRISE CIR N STE 112
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5630
Practice Address - Country:US
Practice Address - Phone:888-543-4039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVONDALE HME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-27
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies