Provider Demographics
NPI:1225888092
Name:AVILA RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:AVILA RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:R
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:276-238-7100
Mailing Address - Street 1:103 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2318
Mailing Address - Country:US
Mailing Address - Phone:276-238-7100
Mailing Address - Fax:
Practice Address - Street 1:545 E STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2218
Practice Address - Country:US
Practice Address - Phone:276-238-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVILA RESIDENTIAL SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty