Provider Demographics
NPI:1205220969
Name:AVENUE HOME CARE
Entity Type:Organization
Organization Name:AVENUE HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MYO
Authorized Official - Middle Name:
Authorized Official - Last Name:TUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-680-7444
Mailing Address - Street 1:3142 TIGER RUN COURT 3117
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010
Mailing Address - Country:US
Mailing Address - Phone:949-680-7444
Mailing Address - Fax:
Practice Address - Street 1:3142 TIGER RUN CT STE 117
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6694
Practice Address - Country:US
Practice Address - Phone:949-680-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care