AVALON MEDICAL DEVELOPMENT CORPORATION

Provider Demographics

• NPI: 1346250347
• Name: AVALON MEDICAL DEVELOPMENT CORPORATION
• Entity type: Organization
• Organization Name: AVALON MEDICAL DEVELOPMENT CORPORATION
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CEO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: JASON
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: PARET
• Authorized Official - Phone: 310-510-0700
• Mailing Address - Street 1: P.O. BOX 1563
• Mailing Address - City: AVALON
• Mailing Address - State: CA
• Mailing Address - Zip Code: 90704-1563
• Mailing Address - Country: US
• Mailing Address - Phone: 310-510-0700
• Mailing Address - Fax: 310-510-2938
• Practice Address - Street 1: 100 FALLS CANYON ROAD
• Practice Address - City: AVALON
• Practice Address - State: CA
• Practice Address - Zip Code: 90704-1563
• Practice Address - Country: US
• Practice Address - Phone: 310-510-0700
• Practice Address - Fax: 310-510-2938
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-09
• Last Update Date: 2024-02-07

Provider Licenses

State	License ID	Taxonomies
CA	930000010	282E00000X, 275N00000X, 261QC0050X, 282NC0060X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	282NC0060X	Hospitals	General Acute Care Hospital	Critical Access
No	282E00000X	Hospitals	Long Term Care Hospital
No	275N00000X	Hospital Units	Medicare Defined Swing Bed Unit
No	261QC0050X	Ambulatory Health Care Facilities	Clinic/Center	Critical Access Hospital

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	RHM03918F	Medicaid
CA	ZZT30427G	Medicaid
AZ	126988	Medicaid
CA	CGP169282	Medicaid
CA	HAP03918F	Medicaid
CO	11732369	Medicaid
CA	ZZT40427G	Medicaid
CA	LTC55187G	Medicaid
CA	LTC55187G	Medicaid
CA	HAP03918F	Medicaid
CA	ZZT30427G	Medicaid
CA	053996	Medicare ID - Type Unspecified	RURAL HEALTH MEDCARE
CA	CGP169282	Medicaid
CA	LTC55187G	Medicaid
CA	555187	Medicare Oscar/Certification