=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700187598
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVALON CONSULTING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2010
-----------------------------------------------------
Last Update Date | 11/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 SAINT JOSEPH DR SUITE 239
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-2428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-934-9012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 SAINT JOSEPH DR SUITE 239
-----------------------------------------------------
City | SAINT JOSEPH
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49085-2428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. KATE MOOD
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 269-934-9012
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 4704176584
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------