Provider Demographics
NPI:1457674046
Name:AVALON CARE, LLC
Entity Type:Organization
Organization Name:AVALON CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-578-3193
Mailing Address - Street 1:33014 FIVE MILE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-3075
Mailing Address - Country:US
Mailing Address - Phone:734-578-3193
Mailing Address - Fax:866-921-7178
Practice Address - Street 1:33014 FIVE MILE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-3075
Practice Address - Country:US
Practice Address - Phone:734-578-3193
Practice Address - Fax:866-921-7178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle