Basic Information
| Provider Information | |||||||||
| NPI: | 1245604925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AVALON VILLA HEALTH CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12029 AVALON BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900612838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237568191 | ||||||||
| FaxNumber: | 3237544031 | ||||||||
| Practice Location | |||||||||
| Address1: | 12029 AVALON BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900612838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237568191 | ||||||||
| FaxNumber: | 3237544031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2015 | ||||||||
| LastUpdateDate: | 03/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | TRESS | ||||||||
| AuthorizedOfficialFirstName: | AVROHOM | ||||||||
| AuthorizedOfficialMiddleName: | LIEB | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 3238233306 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 940000075 | CA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.