Provider Demographics
NPI:1730562224
Name:AVALON PARK HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:AVALON PARK HOME HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-658-6565
Mailing Address - Street 1:12001 AVALON LAKE DR
Mailing Address - Street 2:STE. L
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7375
Mailing Address - Country:US
Mailing Address - Phone:407-658-6565
Mailing Address - Fax:407-658-6246
Practice Address - Street 1:12001 AVALON LAKE DR
Practice Address - Street 2:STE. L
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7375
Practice Address - Country:US
Practice Address - Phone:407-658-6565
Practice Address - Fax:407-658-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health