MEDICARE: AVACARE 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1902440563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVACARE LLC

Provider Business Mailing Address
First Line	:	1055 WESTLAKES DR STE 300
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-2410
Country	:	US
Telephone Number	:	214-934-6476
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 WESTLAKES DR STE 300
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-2410
Country	:	US
Telephone Number	:	214-934-6476
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	HAZVINEI NGOSHI
Credential	:
Telephone Number	:	214-934-6476

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “AVACARE LLC ” Practice Location

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