Provider Demographics
NPI:1649990656
Name:AVALON HOSPICE INC
Entity type:Organization
Organization Name:AVALON HOSPICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-979-5894
Mailing Address - Street 1:2850 W HORIZON RIDGE PARKWAY STE 200 OFFICE 215
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2850 W HORIZON RIDGE PARKWAY STE 200 OFFICE 215
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-979-5894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based