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NPI Code Detail

MEDICARE: AVANA PERSONAL CARE, LLC

MEDICARE: AVANA PERSONAL CARE, LLC
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
1251E00000XHome Health Agency8613-PCS-0NV

General Provider Information

NPI Number : 1598201709
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVANA PERSONAL CARE, LLC
Provider Business Mailing Address
First Line : 4550 W OAKEY BLVD # 111-R
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1581
Country : US
Telephone Number : 702-347-7432
Fax Number : 702-447-7122
Provider Business Practice Location Address
First Line : 4550 W OAKEY BLVD # 111-R
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1581
Country : US
Telephone Number : 702-347-7432
Fax Number : 702-447-7122
Authorized Official
Title or Position : ADMINISTRATOR
Name : MISS GENESIS S BAUTISTA
Credential :
Telephone Number : 702-347-7432
Provider Enumeration Date : 01/11/2017
Last Update Date : 01/11/2017

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Directions to “AVANA PERSONAL CARE, LLC ” Practice Location

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