Provider Demographics
NPI:1740662402
Name:AVONDALE HEALTH SERVICES INC
Entity type:Organization
Organization Name:AVONDALE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WALDEMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-912-5128
Mailing Address - Street 1:3508 KENSINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1328
Mailing Address - Country:US
Mailing Address - Phone:404-294-0203
Mailing Address - Fax:404-294-0208
Practice Address - Street 1:3508 KENSINGTON RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1328
Practice Address - Country:US
Practice Address - Phone:404-294-0203
Practice Address - Fax:404-294-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility