Healthcare Provider Details

I. General information

NPI: 1114718301
Provider Name (Legal Business Name): AVENIR VENTURES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CONTINENTAL DR STE 407
NEWARK DE
19713-4332
US

IV. Provider business mailing address

111 CONTINENTAL DR STE 407
NEWARK DE
19713-4332
US

V. Phone/Fax

Practice location:
  • Phone: 877-202-2869
  • Fax: 866-404-0103
Mailing address:
  • Phone: 877-202-2869
  • Fax: 866-404-0103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS MIGLICCO
Title or Position: SVP TAX
Credential:
Phone: 225-299-3803