Provider Demographics
NPI:1710329123
Name:AVALON'S ASSISTED LIVING
Entity Type:Organization
Organization Name:AVALON'S ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIQQUITTIA
Authorized Official - Middle Name:SE
Authorized Official - Last Name:CARTER-WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-963-0213
Mailing Address - Street 1:1250 WILLOW BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7461
Mailing Address - Country:US
Mailing Address - Phone:407-965-1145
Mailing Address - Fax:407-965-1141
Practice Address - Street 1:1250 WILLOW BRANCH DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7461
Practice Address - Country:US
Practice Address - Phone:407-965-1145
Practice Address - Fax:407-965-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10813310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility