Provider Demographics
NPI:1184098394
Name:AVAVA NURSING SERVICES INC
Entity type:Organization
Organization Name:AVAVA NURSING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:UDEMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-350-8192
Mailing Address - Street 1:8226 LONDONDERRY CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5627
Mailing Address - Country:US
Mailing Address - Phone:240-350-8192
Mailing Address - Fax:
Practice Address - Street 1:630 FREEDOM BUSINESS CTR DR
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1331
Practice Address - Country:US
Practice Address - Phone:240-350-8192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-26
Last Update Date:2015-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA28343601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health