MEDICARE: AVONDALE CARE GROUP 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	251E00000X	Home Health Agency	1625L 001	NY

General Provider Information

NPI Number	:	1962728584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVONDALE CARE GROUP LLC

Provider Business Mailing Address
First Line	:	505 8TH AVE RM 200
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-4681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 8TH AVE RM 803
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-6598
Country	:	US
Telephone Number	:	646-254-6255
Fax Number	:	212-971-4465

Authorized Official
Title or Position	:	FINANCE MANAGER
Name	:	MRS. ALLISON J VIAR
Credential	:
Telephone Number	:	646-254-6255

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	06/11/2012

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