NPIMap

Organization Active NPI

Avondale Health Services Inc.

  • Assisted Living Facility
  • Decatur, GA
National Provider Identifier
1851600324
Registry record updated Oct 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
00483931A Issued in GA
Legal business name
AVONDALE HEALTH SERVICES INC.
Practice address
3508 Kensington Rd
Decatur, GA 30032-1328
Phone
(404) 294-0203
Fax
(404) 294-0208
NPI assigned
Oct 1, 2010
Last updated
Oct 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2010

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

Authorized official

Name
Mr. Trevor Anthony Waldemar, MBA
Title
Vice President
Phone
(404) 294-0203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 00483931A GA Primary

Addresses

Primary practice location

3508 Kensington Rd
Decatur, GA 30032-1328

Mailing address

3508 Kensington Rd
Decatur, GA 30032-1328
Phone (404) 294-0203

Other identifiers 2

IdentifierTypeStateIssuer
300028513BMedicaidGA
300028513AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Avondale Health Services Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3508 Kensington Rd
Decatur, GA 30032
Phone (404) 294-0203

NPI Registry JSON

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

{
    "created_epoch": "1285891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285891200000",
    "number": "1851600324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3508 KENSINGTON RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321328",
            "telephone_number": "404-294-0203",
            "fax_number": "404-294-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3508 KENSINGTON RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321328",
            "telephone_number": "404-294-0203",
            "fax_number": "404-294-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVONDALE HEALTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-01",
        "last_updated": "2010-10-01",
        "status": "A",
        "authorized_official_last_name": "WALDEMAR",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "404-294-0203",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "GA",
            "license": "00483931A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300028513B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300028513A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2010; 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.