MEDICARE: AVONLI CARE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1285107847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVONLI CARE HOME

Provider Business Mailing Address
First Line	:	3364 ROSARIO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2397
Country	:	US
Telephone Number	:	702-982-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	3364 ROSARIO CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-2397
Country	:	US
Telephone Number	:	702-982-1012
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	FAITH RAMOS
Credential	:
Telephone Number	:	702-856-6443

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	01/07/2019

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Directions to “AVONLI CARE HOME ” Practice Location

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