Provider Demographics
NPI:1801142047
Name:AVID HOME HEALTH, INC.
Entity type:Organization
Organization Name:AVID HOME HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO, ALT ADMIN/DON
Authorized Official - Prefix:
Authorized Official - First Name:APPOLONIA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKEREKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-300-0876
Mailing Address - Street 1:8906 WALL ST
Mailing Address - Street 2:BLDG. 3 SUITE 304
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-4541
Mailing Address - Country:US
Mailing Address - Phone:512-300-0876
Mailing Address - Fax:512-300-0871
Practice Address - Street 1:8906 WALL ST
Practice Address - Street 2:BLDG. 3 SUITE 304
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-4541
Practice Address - Country:US
Practice Address - Phone:512-300-0876
Practice Address - Fax:512-300-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
747916Medicare PIN