Healthcare Provider Details

I. General information

NPI: 1184863276
Provider Name (Legal Business Name): ANDVENTURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 ROOSEVELT AVE
SPRINGFIELD MA
01104-1657
US

IV. Provider business mailing address

400 INTERSTATE NORTH PKWY SE STE 1600
ATLANTA GA
30339-5047
US

V. Phone/Fax

Practice location:
  • Phone: 413-731-3050
  • Fax: 413-731-1236
Mailing address:
  • Phone: 470-464-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VICKI WHITESIDE
Title or Position: AVP, REGULATORY LICENSING
Credential:
Phone: 470-464-8000