Healthcare Provider Details

I. General information

NPI: 1154786721
Provider Name (Legal Business Name): AVALON NONPROFIT HOUSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 JONES DR SUITE 102
ANN ARBOR MI
48105-1892
US

IV. Provider business mailing address

1327 JONES DR SUITE 102
ANN ARBOR MI
48105-1892
US

V. Phone/Fax

Practice location:
  • Phone: 734-663-5858
  • Fax: 734-663-4857
Mailing address:
  • Phone: 734-663-5858
  • Fax: 734-663-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JUDE A WALTON
Title or Position: HR / ADMIN DIRECTOR
Credential:
Phone: 734-663-5858