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General NPI Number Information
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NPI Number | 1962335877
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Entity Type | Organization
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Legal Business Name | AVALON CERTIFIED FAMILY HOME
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 2302 S WILDRYE WAY
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City | NAMPA
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State | ID
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Zip | 83686-4920
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Country | US
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Telephone | 208-899-1544
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Fax | 208-544-4030
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Provider Business Mailing Address
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Address Line | 2302 S WILDRYE WAY
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City | NAMPA
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State | ID
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Zip | 83686-4920
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Country | US
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Telephone | 208-899-1544
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Fax | 208-544-4030
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BOBBIE D SPENCER
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Credential | RN
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Telephone | 208-899-1544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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