Provider Demographics
NPI:1346250347
Name:AVALON MEDICAL DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:AVALON MEDICAL DEVELOPMENT CORPORATION
Other - Org Name:CATALINA ISLAND HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-510-0700
Mailing Address - Street 1:P.O. BOX 1563
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:CA
Mailing Address - Zip Code:90704-1563
Mailing Address - Country:US
Mailing Address - Phone:310-510-0700
Mailing Address - Fax:310-510-2938
Practice Address - Street 1:100 FALLS CANYON ROAD
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704-1563
Practice Address - Country:US
Practice Address - Phone:310-510-0700
Practice Address - Fax:310-510-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000010261QC0050X, 275N00000X, 282E00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHM03918FMedicaid
CAZZT30427GMedicaid
AZ126988Medicaid
CACGP169282Medicaid
CAHAP03918FMedicaid
CO11732369Medicaid
CAZZT40427GMedicaid
CALTC55187GMedicaid
CALTC55187GMedicaid
CAHAP03918FMedicaid
CAZZT30427GMedicaid
CA053996Medicare ID - Type UnspecifiedRURAL HEALTH MEDCARE
CACGP169282Medicaid
CALTC55187GMedicaid
CA555187Medicare Oscar/Certification