Provider Demographics
NPI:1356746416
Name:AVALON HOME CARE, INC.
Entity type:Organization
Organization Name:AVALON HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QP
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:320-291-3552
Mailing Address - Street 1:1535 7TH AVE S # 13
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4723
Mailing Address - Country:US
Mailing Address - Phone:763-753-8658
Mailing Address - Fax:
Practice Address - Street 1:1535 7TH AVE S # 13
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4723
Practice Address - Country:US
Practice Address - Phone:763-753-8658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-217455-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health