=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134578602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVID HOME CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2016
-----------------------------------------------------
Last Update Date | 06/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2480 W RUTHRAUFF RD 140-S
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85705-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-888-1724
-----------------------------------------------------
Fax | 520-423-3981
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2480 W RUTHRAUFF RD 140-S
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85705-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-888-1724
-----------------------------------------------------
Fax | 520-423-3981
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. VANESSA VITTORIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 520-888-1724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------