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General NPI Number Information
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NPI Number | 1104118975
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Entity Type | Organization
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Legal Business Name | AVANTI HOME HEALTH OF PALM BEACH CORP
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 1015 GATEWAY BLVD STE 502
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8347
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Country | US
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Telephone | 561-733-1390
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Fax | 561-739-9456
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Provider Business Mailing Address
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Address Line | 1015 GATEWAY BLVD STE 502
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-8347
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Country | US
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Telephone | 561-733-1390
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Fax | 561-739-9456
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Authorized Official
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Title or Position | OWNER, CEO
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Name | MR. MARK CONKLIN
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Credential |
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Telephone | 561-733-1390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299993913
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License Number State | FL
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