Healthcare Provider Details

I. General information

NPI: 1699842211
Provider Name (Legal Business Name): AVONDALE HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 OMEARA DR
HOUSTON TX
77025-5560
US

IV. Provider business mailing address

3737 OMEARA DR
HOUSTON TX
77025-5560
US

V. Phone/Fax

Practice location:
  • Phone: 713-993-9544
  • Fax: 713-993-0751
Mailing address:
  • Phone: 713-993-9544
  • Fax: 713-993-0751

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 TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number115177
License Number StateTX

VIII. Authorized Official

Name: MS. BARBARA BOYETT
Title or Position: C.E.O.
Credential:
Phone: 713-993-9544