MEDICARE: AV 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1972141422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AV CARE AGENCY LLC

Provider Business Mailing Address
First Line	:	2267 S 173RD DR
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85338-1961
Country	:	US
Telephone Number	:	623-248-4342
Fax Number	:	623-248-6096

Provider Business Practice Location Address
First Line	:	2267 S 173RD DR
Second Line	:
City	:	GOODYEAR
State	:	AZ
Zip	:	85338-1961
Country	:	US
Telephone Number	:	623-248-4342
Fax Number	:	623-248-6096

Authorized Official
Title or Position	:	OWNER/ADMIN
Name	:	ANGELA MUHAMMAD
Credential	:
Telephone Number	:	803-600-6939

Provider Enumeration Date	:	12/16/2019
Last Update Date	:	12/16/2019

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Directions to “AV CARE AGENCY LLC ” Practice Location

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