Organization
AVALON HOME CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBEKAH KAY JUDISCH (PRESIDENT)
(763) 753-8658
Entity
Organization
Contact information
Practice address
20132 ULYSSES ST NW, ELK RIVER, MN 55330-2254
(763) 753-8658
Mailing address
20132 ULYSSES ST NW, ELK RIVER, MN 55330-2254
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A003607200
MEDICARE
MN
05
—
A003607200
—
MN
Enumeration date
09/14/2010
Last updated
09/14/2010
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