Provider Demographics
NPI:1902559156
Name:AVENDELLE ASSISTED LIVING DFW LLC
Entity Type:Organization
Organization Name:AVENDELLE ASSISTED LIVING DFW LLC
Other - Org Name:AVENDELLE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANDHERIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-359-7998
Mailing Address - Street 1:5148 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-2106
Mailing Address - Country:US
Mailing Address - Phone:415-359-7998
Mailing Address - Fax:
Practice Address - Street 1:3925 ROYAL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-4048
Practice Address - Country:US
Practice Address - Phone:415-359-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty