Provider Demographics
NPI:1952332736
Name:AVALLON INTERESTS, LP
Entity Type:Organization
Organization Name:AVALLON INTERESTS, LP
Other - Org Name:ANGEL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FRANCIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-453-6449
Mailing Address - Street 1:5828 BALCONES DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4256
Mailing Address - Country:US
Mailing Address - Phone:512-453-6449
Mailing Address - Fax:512-453-6490
Practice Address - Street 1:115 E TRAVIS ST
Practice Address - Street 2:SUITE 445
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-1611
Practice Address - Country:US
Practice Address - Phone:512-453-6449
Practice Address - Fax:512-453-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006915251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000083700Medicaid