Provider Demographics
NPI:1518565498
Name:AVILA HEALTH GROUP LLC
Entity Type:Organization
Organization Name:AVILA HEALTH GROUP LLC
Other - Org Name:AVILA HEALTH GROUP LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YANET
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:TCM'S SUPERVISOR
Authorized Official - Phone:305-373-3424
Mailing Address - Street 1:8323 NW 12TH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1840
Mailing Address - Country:US
Mailing Address - Phone:305-373-3424
Mailing Address - Fax:305-373-3474
Practice Address - Street 1:11402 NW 41ST ST UNIT 206
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4859
Practice Address - Country:US
Practice Address - Phone:305-373-3424
Practice Address - Fax:305-373-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health