Provider Demographics
NPI:1164687737
Name:AVENA STAFFING GROUP LLC
Entity Type:Organization
Organization Name:AVENA STAFFING GROUP LLC
Other - Org Name:AVENA COMPANY LIMITED LIABILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:CHINYE
Authorized Official - Last Name:EMENANJO
Authorized Official - Suffix:
Authorized Official - Credentials:BSC MBPA LPN
Authorized Official - Phone:301-725-6196
Mailing Address - Street 1:15036 COURTLAND PLACE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707
Mailing Address - Country:US
Mailing Address - Phone:301-725-6196
Mailing Address - Fax:301-776-6834
Practice Address - Street 1:15036 COURTLAND PLACE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707
Practice Address - Country:US
Practice Address - Phone:301-725-6196
Practice Address - Fax:301-776-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP41016320900000X
MDR121487323P00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility