Provider Demographics
NPI:1740704451
Name:AVALANCHE CARE INC
Entity type:Organization
Organization Name:AVALANCHE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PTIENT'S SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOVELY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEUDY-PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-200-1117
Mailing Address - Street 1:22005 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-2140
Mailing Address - Country:US
Mailing Address - Phone:718-454-2038
Mailing Address - Fax:888-503-1828
Practice Address - Street 1:130 ROUTE 59 STE 2
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5229
Practice Address - Country:US
Practice Address - Phone:845-517-2292
Practice Address - Fax:845-352-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0323901Medicaid