# AVENA STAFFING GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avena Company Limited Liability
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164687737
- **Authorized official:** MRS. VICTORIA CHINYE EMENANJO BSC MBPA LPN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (301) 725-6196

## Contact information

- **Practice address:** 15036 COURTLAND PLACE, LAUREL, MD 20707
- **Practice address phone:** (301) 725-6196
- **Practice address fax:** (301) 776-6834
- **Mailing address:** 15036 COURTLAND PLACE, LAUREL, MD 20707
- **Mailing address phone:** (301) 725-6196
- **Mailing address fax:** (301) 776-6834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320900000X | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | LP41016 | MD | — |
| 323P00000X | Psychiatric Residential Treatment Facility | R121487 | MD | — |
| 385H00000X | Respite Care | R121487 | MD | Yes |

## Other

- **Enumeration date:** 07/23/2008
- **Last updated:** 07/23/2008