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General NPI Number Information
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NPI Number | 1902559156
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Entity Type | Organization
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Legal Business Name | AVENDELLE ASSISTED LIVING DFW LLC
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Dates
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Enumeration Date | 01/28/2022
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 3925 ROYAL LN
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City | DALLAS
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State | TX
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Zip | 75229-4048
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Country | US
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Telephone | 415-359-7998
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Fax |
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Provider Business Mailing Address
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Address Line | 5148 PARADISE DR
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City | CORTE MADERA
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State | CA
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Zip | 94925-2106
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Country | US
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Telephone | 415-359-7998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AJOY KHANDHERIA
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Credential |
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Telephone | 415-359-7998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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