Provider Demographics
NPI:1356778203
Name:AVENUE HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:AVENUE HOME HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE GOLDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-915-7478
Mailing Address - Street 1:5440 N STATE ROAD 7
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2956
Mailing Address - Country:US
Mailing Address - Phone:954-915-7478
Mailing Address - Fax:954-333-3963
Practice Address - Street 1:5440 N STATE ROAD 7
Practice Address - Street 2:SUITE 208
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33319-2956
Practice Address - Country:US
Practice Address - Phone:954-915-7478
Practice Address - Fax:954-333-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-07
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233310253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care