Provider Demographics
NPI:1649391822
Name:AVERY ENTERPRISES
Entity Type:Organization
Organization Name:AVERY ENTERPRISES
Other - Org Name:COMPREHENSIVE SERVICES FOR SENIORS AND DISABLED INDIVIDUALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:ARNITA
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN,MED, EDD
Authorized Official - Phone:704-654-9505
Mailing Address - Street 1:PO BOX 241074
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28224-1074
Mailing Address - Country:US
Mailing Address - Phone:704-654-9505
Mailing Address - Fax:
Practice Address - Street 1:10109 FAIRLEA DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8737
Practice Address - Country:US
Practice Address - Phone:704-654-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3672251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health