MEDICARE: AVALON HOME HEALTH INC.

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	550001400	CA

General Provider Information

NPI Number	:	1417335720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALON HOME HEALTH INC.

Provider Business Mailing Address
First Line	:	303 TWIN DOLPHIN DR
Second Line	:	SUITE 600
City	:	REDWOOD CITY
State	:	CA
Zip	:	94065-1497
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 TWIN DOLPHIN DR
Second Line	:	SUITE 600
City	:	REDWOOD CITY
State	:	CA
Zip	:	94065-1497
Country	:	US
Telephone Number	:	415-812-2955
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEX RUDAKOV
Credential	:
Telephone Number	:	415-812-2955

Provider Enumeration Date	:	05/07/2015
Last Update Date	:	10/21/2015

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