Provider Demographics
NPI:1164477089
Name:AVALON HOME, INC.
Entity type:Organization
Organization Name:AVALON HOME, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-733-8700
Mailing Address - Street 1:14014 MARSH PIKE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1638
Mailing Address - Country:US
Mailing Address - Phone:301-733-8700
Mailing Address - Fax:301-733-8700
Practice Address - Street 1:14014 MARSH PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1638
Practice Address - Country:US
Practice Address - Phone:301-733-8700
Practice Address - Fax:301-733-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21-001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
278161OtherAMERIGROUP
02MMOtherCAREFIRST - PROV INQ#
5522258OtherAETNA-HMO
RT3OtherCAREFIRST - BLUE CHOICE
RT3OtherCAREFIRST - IND/PPO
=========OtherAETNA-NONHMO
=========OtherJOHN HOPKINS
=========OtherCAREFIRST - TIN
=========OtherMARYLAND PHYSICIAN CARE
RT3OtherCAREFIRST - BLUE CHOICE
02MMOtherCAREFIRST - PROV \ INQ#
=========OtherCOVENTRY - HMO
=========OtherCOVENTRY - PPO
=========OtherCOVENTRY - DIAMOND PLAN
RT3OtherCAREFIRST - IND/PPO