Provider Demographics
NPI:1922411735
Name:AVALON POST ACUTE LLC
Entity Type:Organization
Organization Name:AVALON POST ACUTE LLC
Other - Org Name:AVALON POST ACUTE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:MS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-389-6900
Mailing Address - Street 1:4032 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-3405
Mailing Address - Country:US
Mailing Address - Phone:213-389-6900
Mailing Address - Fax:
Practice Address - Street 1:12029 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2838
Practice Address - Country:US
Practice Address - Phone:323-756-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility