Provider Demographics
NPI:1689712721
Name:AVONDALE HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:AVONDALE HEALTH SERVICES, INC
Other - Org Name:AVONDALE HOMES AT TUCKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDEMAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-294-0203
Mailing Address - Street 1:3508 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1328
Mailing Address - Country:US
Mailing Address - Phone:404-294-0203
Mailing Address - Fax:404-294-0208
Practice Address - Street 1:2553 SANDPIPER DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-2910
Practice Address - Country:US
Practice Address - Phone:770-393-0122
Practice Address - Fax:404-294-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility