Healthcare Provider Details

I. General information

NPI: 1326522004
Provider Name (Legal Business Name): AVESTA CARE MEDICAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5853 BREWBAKER BLVD
MONTGOMERY AL
36116
US

IV. Provider business mailing address

5853 BREWBAKER BLVD
MONTGOMERY AL
36116-4259
US

V. Phone/Fax

Practice location:
  • Phone: 334-316-5080
  • Fax:
Mailing address:
  • Phone: 334-316-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: REGINA MITCHELL
Title or Position: OWNER
Credential: LPN
Phone: 334-316-5080