=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902343353
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVALON HOSPICE MINNESOTA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2017
-----------------------------------------------------
Last Update Date | 01/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8000 W 78TH ST STE 210
-----------------------------------------------------
City | EDINA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55439-2549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-361-0022
-----------------------------------------------------
Fax | 844-587-4798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4060
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28117-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-664-2876
-----------------------------------------------------
Fax | 704-230-0946
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF LICENSURE
-----------------------------------------------------
Name | MS. JANET COMBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 704-662-1761
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------