Provider Demographics
NPI:1689217945
Name:AVALON PEDIATRIC HOME HEALTH INC
Entity Type:Organization
Organization Name:AVALON PEDIATRIC HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:IWEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-367-7275
Mailing Address - Street 1:14910 MILL BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-0905
Mailing Address - Country:US
Mailing Address - Phone:713-367-7275
Mailing Address - Fax:
Practice Address - Street 1:14910 MILL BRANCH LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-0905
Practice Address - Country:US
Practice Address - Phone:713-367-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health