Healthcare Provider Details

I. General information

NPI: 1639924970
Provider Name (Legal Business Name): AVALON ADULT DAY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17274 WILD WATERMELON WAY
CONROE TX
77302-1408
US

IV. Provider business mailing address

4115 LOUETTA RD APT 2106
SPRING TX
77388-4877
US

V. Phone/Fax

Practice location:
  • Phone: 561-396-7725
  • Fax:
Mailing address:
  • Phone: 561-396-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: ANGELA GAIL YOUNG
Title or Position: OWNER
Credential:
Phone: 561-396-7725