Provider Demographics
NPI:1083404909
Name:AVCG CARE GROUP INCORPORATED
Entity type:Organization
Organization Name:AVCG CARE GROUP INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL ANTHONY
Authorized Official - Middle Name:DITA
Authorized Official - Last Name:CONVENTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-289-0180
Mailing Address - Street 1:8237 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5175 VAN BUREN BLVD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2618
Practice Address - Country:US
Practice Address - Phone:951-289-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No385H00000XRespite Care FacilityRespite Care
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251V00000XAgenciesVoluntary or Charitable