Provider Demographics
NPI:1134127392
Name:AVALON HEALTH CARE, LLC.
Entity Type:Organization
Organization Name:AVALON HEALTH CARE, LLC.
Other - Org Name:TREVECCA HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:EMILY
Authorized Official - Last Name:WHITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-255-9670
Mailing Address - Street 1:217 BLANTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-4703
Mailing Address - Country:US
Mailing Address - Phone:615-255-9670
Mailing Address - Fax:615-255-2234
Practice Address - Street 1:329 MURFREESBORO RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2834
Practice Address - Country:US
Practice Address - Phone:615-244-6900
Practice Address - Fax:615-255-1893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000066314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7440259Medicaid
TN1000650OtherBLUE CROSS BLUE SHIELD #
TN0445112Medicaid
TN0445112Medicaid