Provider Demographics
NPI:1821458514
Name:AVATAR CA
Entity Type:Organization
Organization Name:AVATAR CA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-389-3013
Mailing Address - Street 1:9505 WELLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2579
Mailing Address - Country:US
Mailing Address - Phone:813-389-3013
Mailing Address - Fax:
Practice Address - Street 1:9505 WELLSTONE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2579
Practice Address - Country:US
Practice Address - Phone:813-389-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1961
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health