Healthcare Provider Details

I. General information

NPI: 1205700556
Provider Name (Legal Business Name): AVITAL HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12808 W AIRPORT BLVD STE 220
SUGAR LAND TX
77478-6185
US

IV. Provider business mailing address

12808 W AIRPORT BLVD STE 220
SUGAR LAND TX
77478-6185
US

V. Phone/Fax

Practice location:
  • Phone: 832-866-4198
  • Fax:
Mailing address:
  • Phone: 832-866-4198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: SUSAN OLUMOROTI
Title or Position: CEO
Credential:
Phone: 832-866-4198