Healthcare Provider Details

I. General information

NPI: 1740704451
Provider Name (Legal Business Name): AVALANCHE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ROUTE 59 STE 2
SPRING VALLEY NY
10977-5229
US

IV. Provider business mailing address

22005 JAMAICA AVE
QUEENS VILLAGE NY
11428-2140
US

V. Phone/Fax

Practice location:
  • Phone: 845-517-2292
  • Fax: 845-352-1045
Mailing address:
  • Phone: 718-454-2038
  • Fax: 888-503-1828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOVELY JEUDY-PIERRE
Title or Position: DIRECTOR OF PTIENT'S SERVICES
Credential:
Phone: 845-200-1117