Provider Demographics
NPI:1467952143
Name:AVOCA HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:AVOCA HEALTHCARE GROUP, LLC
Other - Org Name:ALOTT OF CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LANDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-399-8735
Mailing Address - Street 1:2414 W OLD PAINT TRL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6608
Mailing Address - Country:US
Mailing Address - Phone:480-399-8735
Mailing Address - Fax:
Practice Address - Street 1:2237 N AVOCA
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-2028
Practice Address - Country:US
Practice Address - Phone:480-399-8735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YM0800X, 2080P0006X
AZAL10378H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ266067Medicaid