# AVALONIA GROUP HOMES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073699617
- **Authorized official:** MR. JOHN M. SHORT (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (864) 836-7220

## Contact information

- **Practice address:** 213 HART CUT RD, MARIETTA, SC 29661-9687
- **Practice address phone:** (864) 836-7220
- **Practice address fax:** (864) 294-1774
- **Mailing address:** PO BOX 699, MARIETTA, SC 29661-0699
- **Mailing address phone:** (864) 836-7220
- **Mailing address fax:** (864) 294-1774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | SR-0008124001-CC1 | SC | Yes |

## Other

- **Enumeration date:** 10/27/2006
- **Last updated:** 01/12/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 993MXH | — | SC |