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General NPI Number Information
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NPI Number | 1821465204
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Entity Type | Organization
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Legal Business Name | AFFORDABLE VENTURE HOME HEALTHCARE LLC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 8626 TESORO DR STE 205G
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City | SAN ANTONIO
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State | TX
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Zip | 78217-6217
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Country | US
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Telephone | 210-562-3474
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Fax | 210-562-3429
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Provider Business Mailing Address
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Address Line | 12900 E LOOP 1604 N APT 911
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City | UNIVERSAL CITY
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State | TX
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Zip | 78148-3177
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALICE MANYONG ENYONG
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Credential | LVN, BSA
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Telephone | 617-230-4437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251T00000X
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Taxonomy Name | PACE Provider Organization
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License Number | 016973
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 016973
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License Number State | TX
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