Provider Demographics
NPI:1659547792
Name:THE AVALON ASSISTED LIVING AND WELLNESS CENTER
Entity Type:Organization
Organization Name:THE AVALON ASSISTED LIVING AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZACCHEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-462-4000
Mailing Address - Street 1:32 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5224
Mailing Address - Country:US
Mailing Address - Phone:845-462-4000
Mailing Address - Fax:845-462-2074
Practice Address - Street 1:1629 ROUTE 376
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-6140
Practice Address - Country:US
Practice Address - Phone:845-463-0500
Practice Address - Fax:845-463-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230-F-068310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02113362Medicaid