=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154786721
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVALON NONPROFIT HOUSING CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2015
-----------------------------------------------------
Last Update Date | 12/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1327 JONES DR SUITE 102
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-1892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-663-5858
-----------------------------------------------------
Fax | 734-663-4857
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1327 JONES DR SUITE 102
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48105-1892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-663-5858
-----------------------------------------------------
Fax | 734-663-4857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HR / ADMIN DIRECTOR
-----------------------------------------------------
Name | JUDE A WALTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-663-5858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------