MEDICARE: AVATAR HOME HEALTH CARE AGENCY, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1528314820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVATAR HOME HEALTH CARE AGENCY, LLC

Provider Business Mailing Address
First Line	:	25325 BOROUGH PARK DR STE 100
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3564
Country	:	US
Telephone Number	:	281-465-8220
Fax Number	:	281-298-7502

Provider Business Practice Location Address
First Line	:	25325 BOROUGH PARK DR STE 100
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77380-3564
Country	:	US
Telephone Number	:	281-465-8220
Fax Number	:	281-298-7502

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. FELIX N. CANABAL
Credential	:
Telephone Number	:	281-465-8220

Provider Enumeration Date	:	07/24/2012
Last Update Date	:	10/12/2023

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