Healthcare Provider Details

I. General information

NPI: 1437006194
Provider Name (Legal Business Name): AVALON RESIDENTIAL NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N JEFFERSON ST
SAINT JAMES MO
65559-1919
US

IV. Provider business mailing address

PO BOX 322
SAINT JAMES MO
65559-0322
US

V. Phone/Fax

Practice location:
  • Phone: 573-647-0927
  • Fax:
Mailing address:
  • Phone: 417-413-0429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY CARL MCDONALD
Title or Position: OWNER/MANAGING MEMBER
Credential:
Phone: 417-413-0429