Provider Demographics
NPI:1760002299
Name:AVALON OUTPATIENT SERVICES
Entity Type:Organization
Organization Name:AVALON OUTPATIENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC-CA
Authorized Official - Phone:562-980-6639
Mailing Address - Street 1:1547 N AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1552
Mailing Address - Country:US
Mailing Address - Phone:424-477-5334
Mailing Address - Fax:562-324-6274
Practice Address - Street 1:1547 N AVALON BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1552
Practice Address - Country:US
Practice Address - Phone:424-477-5334
Practice Address - Fax:562-324-6274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit