Provider Demographics
NPI:1750903324
Name:AVERY'S AT HOMECARE, LLC
Entity type:Organization
Organization Name:AVERY'S AT HOMECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:RAGAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:225-242-9342
Mailing Address - Street 1:400 CONWAY VILLAGE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8284
Mailing Address - Country:US
Mailing Address - Phone:225-242-9342
Mailing Address - Fax:225-208-1384
Practice Address - Street 1:400 CONWAY VILLAGE BLVD STE 208
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8284
Practice Address - Country:US
Practice Address - Phone:225-242-9342
Practice Address - Fax:225-208-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-17
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty