Provider Demographics
NPI:1649043464
Name:AVALON ALLIANCE HOMECARE, LLC
Entity type:Organization
Organization Name:AVALON ALLIANCE HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-288-9775
Mailing Address - Street 1:6515 E 82ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1544
Mailing Address - Country:US
Mailing Address - Phone:317-288-9775
Mailing Address - Fax:317-288-9758
Practice Address - Street 1:6515 E 82ND ST STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1544
Practice Address - Country:US
Practice Address - Phone:317-288-9775
Practice Address - Fax:317-288-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health