MEDICARE: AVALANCHE CARE 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	0654L002	NY

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

General Provider Information

NPI Number	:	1710438155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVALANCHE CARE INC

Provider Business Mailing Address
First Line	:	130 ROUTE 59
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5203
Country	:	US
Telephone Number	:	845-517-2292
Fax Number	:	845-352-1045

Provider Business Practice Location Address
First Line	:	130 ROUTE 59
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5203
Country	:	US
Telephone Number	:	845-517-2292
Fax Number	:	845-352-1045

Authorized Official
Title or Position	:	DPS/OWNER
Name	:	LOVELY JEUDY PIERRE
Credential	:
Telephone Number	:	845-517-2292

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	10/20/2016

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Directions to “AVALANCHE CARE INC ” Practice Location

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