Organization
AVENUE SUPPORTIVE CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GOLDIE LOZIER LOUIS (ADMINISTRATOR)
(954) 716-6527
Entity
Organization
Contact information
Practice address
5440 N STATE ROAD 7, SUITE 208, FORT LAUDERDALE, FL 33319-2956
(954) 716-6527
Mailing address
PO BOX 26222, TAMARAC, FL 33320-6222
(954) 716-6527
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
233310
FL
Other
Enumeration date
03/07/2014
Last updated
03/07/2014
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