Avalon Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

AVALON HOSPICE, LLC

Practice address

403 1St St
Idaho Falls, ID 83401-3928

Phone

(208) 419-0896

Fax

(208) 419-0974

NPI assigned

Oct 21, 2011

Last updated

Oct 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jacob Raymond Bryan, MOT

Title

Owner

Phone

(208) 419-0896

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319155200000",
    "number": "1497031421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 1ST ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013928",
            "telephone_number": "208-419-0896",
            "fax_number": "208-419-0974"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 1ST ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013928",
            "telephone_number": "208-419-0896",
            "fax_number": "208-419-0974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-21",
        "last_updated": "2011-10-21",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "RAYMOND",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-419-0896",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MOT"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Community Based Hospice Care Agency in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.