Provider Demographics
NPI:1699842211
Name:AVONDALE HOUSE
Entity Type:Organization
Organization Name:AVONDALE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-993-9544
Mailing Address - Street 1:3737 OMEARA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5560
Mailing Address - Country:US
Mailing Address - Phone:713-993-9544
Mailing Address - Fax:713-993-0751
Practice Address - Street 1:3737 OMEARA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5560
Practice Address - Country:US
Practice Address - Phone:713-993-9544
Practice Address - Fax:713-993-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
TX115177320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001000726Medicaid