Healthcare Provider Details

I. General information

NPI: 1073320156
Provider Name (Legal Business Name): AVAL 1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 COUNTRY TIME CIR
LEICESTER NC
28748-0647
US

IV. Provider business mailing address

235 COUNTRY TIME CIR
LEICESTER NC
28748-0647
US

V. Phone/Fax

Practice location:
  • Phone: 828-582-4537
  • Fax: 828-484-2755
Mailing address:
  • Phone: 828-582-4537
  • Fax: 828-484-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JUSTINA DENISE MUNIZ
Title or Position: MANAGING MEMBER
Credential:
Phone: 828-582-4537