Provider Demographics
NPI:1710937677
Name:AVATAR HOME HEALTH CARE AGENCY, LLC
Entity Type:Organization
Organization Name:AVATAR HOME HEALTH CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT. ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:NICOMEDES
Authorized Official - Last Name:CANABAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-465-8220
Mailing Address - Street 1:25325 BOROUGH PARK DRIVE
Mailing Address - Street 2:SUITE #100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-465-8220
Mailing Address - Fax:281-298-7502
Practice Address - Street 1:25325 BOROUGH PARK DRIVE
Practice Address - Street 2:SUITE #100
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-465-8220
Practice Address - Fax:281-298-7502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010674251E00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016077Medicaid
TX001016078Medicaid
TX1867061-01Medicaid
TX001016077Medicaid