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General NPI Number Information
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NPI Number | 1629359674
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Entity Type | Organization
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Legal Business Name | AVALON HOME HEALTH INC
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Dates
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Enumeration Date | 09/05/2011
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Last Update Date | 09/05/2011
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Provider Practice Location Address
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Address Line | 777 CAMPUS COMMONS RD SUITE 200
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City | SACRAMENTO
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State | CA
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Zip | 95825-8309
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Country | US
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Telephone | 415-812-2955
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Fax |
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Provider Business Mailing Address
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Address Line | 2880 ZANKER RD STE 203
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City | SAN JOSE
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State | CA
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Zip | 95134-2122
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Country | US
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Telephone | 415-812-2955
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEKSANDER RUDAKOV
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Credential |
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Telephone | 415-812-2955
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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 | 550001400
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License Number State | CA
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