MEDICARE: AVATAR STAFFING, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1376094292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVATAR STAFFING, LLC

Provider Business Mailing Address
First Line	:	25325 BOROUGH PARK DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3569
Country	:	US
Telephone Number	:	281-703-8050
Fax Number	:

Provider Business Practice Location Address
First Line	:	25325 BOROUGH PARK DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3569
Country	:	US
Telephone Number	:	281-703-8050
Fax Number	:

Authorized Official
Title or Position	:	ALT. ADMINISTRATOR
Name	:	MR. FELIX CANABAL
Credential	:
Telephone Number	:	281-703-8050

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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