Provider Demographics
NPI:1821387473
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:N
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:2011-04-05
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010674251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based