MEDICARE: AVALON HEALTH CARE, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0000000066	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1000650	OTHER	TN	BLUE CROSS BLUE SHIELD #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134127392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON HEALTH CARE, LLC.

Provider Business Mailing Address
First Line	:	217 BLANTON AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-4703
Country	:	US
Telephone Number	:	615-255-9670
Fax Number	:	615-255-2234

Provider Business Practice Location Address
First Line	:	329 MURFREESBORO RD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-2834
Country	:	US
Telephone Number	:	615-244-6900
Fax Number	:	615-255-1893

Authorized Official
Title or Position	:	VICE PRESIDENT OPERATIONS
Name	:	MARY EMILY WHITCOMB
Credential	:
Telephone Number	:	615-255-9670

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	05/19/2008

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