Healthcare Provider Details

I. General information

NPI: 1104412865
Provider Name (Legal Business Name): AVENEL HEALTHCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MERCANTILE LN STE 203
LARGO MD
20774-4304
US

IV. Provider business mailing address

1401 MERCANTILE LN STE 203
LARGO MD
20774-4304
US

V. Phone/Fax

Practice location:
  • Phone: 240-582-7775
  • Fax: 240-582-7972
Mailing address:
  • Phone: 240-582-7775
  • Fax: 240-582-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. CALEB I SOLOMON
Title or Position: VICE PRESIDENT
Credential:
Phone: 240-535-3736