Provider Demographics
NPI:1457084097
Name:AVID AT HOME LLC
Entity Type:Organization
Organization Name:AVID AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-337-4796
Mailing Address - Street 1:810 CARDINAL LN STE 230
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2390
Mailing Address - Country:US
Mailing Address - Phone:262-337-4796
Mailing Address - Fax:
Practice Address - Street 1:810 CARDINAL LN STE 230
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2390
Practice Address - Country:US
Practice Address - Phone:262-337-4796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health