Provider Demographics
NPI:1922780261
Name:AVELLA PRIVATE HOME CARE LLC
Entity Type:Organization
Organization Name:AVELLA PRIVATE HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-648-4333
Mailing Address - Street 1:400 CHESTERFIELD CTR STE 400
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4800
Mailing Address - Country:US
Mailing Address - Phone:314-648-4338
Mailing Address - Fax:
Practice Address - Street 1:400 CHESTERFIELD CTR STE 400
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4800
Practice Address - Country:US
Practice Address - Phone:314-648-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care