Provider Demographics
NPI:1346893393
Name:AVISTACARE HEALTH CARE SERVICES INC
Entity Type:Organization
Organization Name:AVISTACARE HEALTH CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OFONASAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:EYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-469-9168
Mailing Address - Street 1:10402 SOUTHERN HAWKER
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-2200
Mailing Address - Country:US
Mailing Address - Phone:832-469-9168
Mailing Address - Fax:
Practice Address - Street 1:10402 SOUTHERN HAWKER
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-2200
Practice Address - Country:US
Practice Address - Phone:832-469-9168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health