Healthcare Provider Details

I. General information

NPI: 1457888745
Provider Name (Legal Business Name): AVONDALE CARE GROUP OF PENNSYLVANIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7371 THOMAS BLVD STE 209
PITTSBURGH PA
15208-2508
US

IV. Provider business mailing address

400 PERIMETER CENTER TER NE STE 300
ATLANTA GA
30346-1201
US

V. Phone/Fax

Practice location:
  • Phone: 412-730-2425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ELAZAR HUISMAN
Title or Position: NPI MANAGER
Credential:
Phone: 404-418-7484