Healthcare Provider Details

I. General information

NPI: 1174788640
Provider Name (Legal Business Name): AVALON HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 LINDELL DR
APEX NC
27539-5390
US

IV. Provider business mailing address

4428 LOUISBURG RD SUITE 109
RALEIGH NC
27616-4302
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-7429
  • Fax:
Mailing address:
  • Phone: 336-253-2219
  • Fax: 919-872-7456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number092713
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: IJEOMA NWANKWO
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-253-2219