Provider Demographics
NPI:1821465204
Name:AFFORDABLE VENTURE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:AFFORDABLE VENTURE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:MANYONG
Authorized Official - Last Name:ENYONG
Authorized Official - Suffix:
Authorized Official - Credentials:LVN, BSA
Authorized Official - Phone:617-230-4437
Mailing Address - Street 1:12900 E LOOP 1604 N APT 911
Mailing Address - Street 2:
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3177
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8626 TESORO DR STE 205G
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6217
Practice Address - Country:US
Practice Address - Phone:210-562-3474
Practice Address - Fax:210-562-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX016973251T00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization