Provider Demographics
NPI:1508598715
Name:AVONLEA HOMES
Entity Type:Organization
Organization Name:AVONLEA HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-481-7716
Mailing Address - Street 1:17813 TREE LAWN DR
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-3344
Mailing Address - Country:US
Mailing Address - Phone:240-899-5890
Mailing Address - Fax:
Practice Address - Street 1:3432 CANBERRA ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1705
Practice Address - Country:US
Practice Address - Phone:240-899-5890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities