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General NPI Number Information
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NPI Number | 1346658002
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Entity Type | Organization
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Legal Business Name | ANTELOPE VALLEY EPSDT & WAIVERS AGENCY, CORP
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Dates
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Enumeration Date | 07/25/2014
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 1431 W ROSAMOND BLVD #14D
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City | ROSAMOND
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State | CA
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Zip | 93560-7428
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Country | US
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Telephone | 661-952-9512
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Fax |
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Provider Business Mailing Address
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Address Line | 25379 WAYNE MILLS PL #134
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City | VALENCIA
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State | CA
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Zip | 91355-1827
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Country | US
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Telephone | 661-952-9512
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JAMIE SCHNABEL
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Credential |
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Telephone | 661-952-9512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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