MEDICARE: AVIANA 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	311Z00000X	Custodial Care Facility	008149	GA

General Provider Information

NPI Number	:	1760826739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIANA LLC

Provider Business Mailing Address
First Line	:	2805 BARBARA RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2222
Country	:	US
Telephone Number	:	706-315-7245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2805 BARBARA RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31907-2222
Country	:	US
Telephone Number	:	706-315-7245
Fax Number	:

Authorized Official
Title or Position	:	RN ADMINISTRATOR
Name	:	MRS. ANGELA S CANTRELL
Credential	:
Telephone Number	:	706-315-7245

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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Directions to “AVIANA LLC ” Practice Location

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