Provider Demographics
NPI:1174328942
Name:AVALIA HEALTH LLC
Entity type:Organization
Organization Name:AVALIA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN RAVENSWAAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-531-0027
Mailing Address - Street 1:PO BOX 140968
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0968
Mailing Address - Country:US
Mailing Address - Phone:907-531-0027
Mailing Address - Fax:
Practice Address - Street 1:3519 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1111
Practice Address - Country:US
Practice Address - Phone:907-868-1105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty