Provider Demographics
NPI:1407587132
Name:AVOW-U HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:AVOW-U HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZUAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-868-3989
Mailing Address - Street 1:19747 TERRAZZA LAKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1909
Mailing Address - Country:US
Mailing Address - Phone:916-868-3989
Mailing Address - Fax:916-868-3989
Practice Address - Street 1:19747 TERRAZZA LAKE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1909
Practice Address - Country:US
Practice Address - Phone:916-868-3989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX616273658Medicaid