Healthcare Provider Details

I. General information

NPI: 1578189957
Provider Name (Legal Business Name): AVENIR VENTURES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 CONCORD AVE
GRAND ISLAND NE
68803-4911
US

IV. Provider business mailing address

3854 AMERICAN WAY STE A
BATON ROUGE LA
70816-4897
US

V. Phone/Fax

Practice location:
  • Phone: 877-202-2869
  • Fax: 877-410-0610
Mailing address:
  • Phone: 225-292-2031
  • Fax: 225-295-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS MIGLICCO
Title or Position: SVP TAX
Credential:
Phone: 225-299-3803