MEDICARE: AVONDALE 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	:	1992278568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVONDALE CARE HOME

Provider Business Mailing Address
First Line	:	6215 E OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1802
Country	:	US
Telephone Number	:	702-778-2753
Fax Number	:	702-778-2753

Provider Business Practice Location Address
First Line	:	6215 E OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1802
Country	:	US
Telephone Number	:	702-778-2753
Fax Number	:	702-778-2753

Authorized Official
Title or Position	:	CEO
Name	:	SUTHINEE AGCAOILI LAONIYOMTHAI
Credential	:
Telephone Number	:	702-767-0311

Provider Enumeration Date	:	01/07/2019
Last Update Date	:	04/25/2024

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