MEDICARE: AVALON FAMILY SERVICES, 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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1255725776
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON FAMILY SERVICES, LLC

Provider Business Mailing Address
First Line	:	2816 E ROBINSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5828
Country	:	US
Telephone Number	:	407-470-0819
Fax Number	:	407-823-7638

Provider Business Practice Location Address
First Line	:	2816 E ROBINSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-5828
Country	:	US
Telephone Number	:	407-470-0819
Fax Number	:	407-823-7638

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JUDYTHE E PEPIN
Credential	:
Telephone Number	:	407-470-0819

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	03/23/2015

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