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General NPI Number Information
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NPI Number | 1801121769
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Entity Type | Organization
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Legal Business Name | AVISTA HOME HEALTHCARE LLC
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Dates
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Enumeration Date | 10/11/2009
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Last Update Date | 10/13/2009
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Provider Practice Location Address
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Address Line | 5237 OAKMAN BLVD STE D
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City | DEARBORN
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State | MI
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Zip | 48126-4045
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Country | US
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Telephone | 586-405-0341
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Fax |
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Provider Business Mailing Address
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Address Line | 5237 OAKMAN BLVD STE D
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City | DEARBORN
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State | MI
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Zip | 48126-4045
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Country | US
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Telephone | 586-405-0341
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. AVIS HANY CHOULAGH
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Credential | J.D.
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Telephone | 586-405-0341
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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 |
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License Number State |
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