Provider Demographics
NPI:1891904405
Name:AVANTI HOME HEALTH CARE PLLC
Entity Type:Organization
Organization Name:AVANTI HOME HEALTH CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:EVANGELISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-779-9900
Mailing Address - Street 1:37650 PROFESSIONAL CENTER DR
Mailing Address - Street 2:STE 145-A
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1197
Mailing Address - Country:US
Mailing Address - Phone:734-779-9900
Mailing Address - Fax:734-779-9100
Practice Address - Street 1:37650 PROFESSIONAL CENTER DR
Practice Address - Street 2:STE 145-A
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1197
Practice Address - Country:US
Practice Address - Phone:734-779-9900
Practice Address - Fax:734-779-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23-7668251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-7668Medicare ID - Type Unspecified