Healthcare Provider Details

I. General information

NPI: 1164822110
Provider Name (Legal Business Name): AVONDALE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31214 ROOS RIVER DR
HOCKLEY TX
77447-2216
US

IV. Provider business mailing address

31214 ROOS RIVER DR
HOCKLEY TX
77447-2216
US

V. Phone/Fax

Practice location:
  • Phone: 832-762-0418
  • Fax: 832-653-7969
Mailing address:
  • Phone: 832-762-0418
  • Fax: 832-653-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: ROCHELLE WRIGHT-WILLIAMS
Title or Position: OWNER/PROGRAM MANAGER
Credential: CASE MANAGER
Phone: 832-762-0418