Provider Demographics
NPI:1336548452
Name:AVRA VALLEY ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:AVRA VALLEY ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:APODACA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-622-0488
Mailing Address - Street 1:1621 N SILVERBELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1816
Mailing Address - Country:US
Mailing Address - Phone:520-622-0488
Mailing Address - Fax:520-622-0487
Practice Address - Street 1:1621 N SILVERBELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1816
Practice Address - Country:US
Practice Address - Phone:520-622-0488
Practice Address - Fax:520-622-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL9456H310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAL9456HOtherASSISTED LIVING HOME