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General NPI Number Information
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NPI Number | 1982844262
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Entity Type | Organization
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Legal Business Name | AVANTA HOME HEALTH CARE SERVICES, INC.
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 28880 SOUTHFIELD RD STE 181
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2700
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Country | US
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Telephone | 248-563-1989
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Fax |
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Provider Business Mailing Address
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Address Line | 28880 SOUTHFIELD RD STE 181
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-2700
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Country | US
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Telephone | 248-563-1989
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CARMELITA JOQUICO
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Credential | RN, BSN
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Telephone | 248-563-1989
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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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