Provider Demographics
NPI:1417335720
Name:AVALON HOME HEALTH INC.
Entity Type:Organization
Organization Name:AVALON HOME HEALTH INC.
Other - Org Name:NATIONAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-812-2955
Mailing Address - Street 1:303 TWIN DOLPHIN DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 TWIN DOLPHIN DR
Practice Address - Street 2:SUITE 600
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1497
Practice Address - Country:US
Practice Address - Phone:415-812-2955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550001400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health