Provider Demographics
NPI:1346540507
Name:AVAYA HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:AVAYA HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-741-2216
Mailing Address - Street 1:2410 TAYLOR ST
Mailing Address - Street 2:SUITE 22419
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-8452
Mailing Address - Country:US
Mailing Address - Phone:214-580-8271
Mailing Address - Fax:
Practice Address - Street 1:2410 TAYLOR ST
Practice Address - Street 2:SUITE 22419
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-8452
Practice Address - Country:US
Practice Address - Phone:214-580-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health