Organization
AVANT SUPPORTED LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRITTANI GARDNER EVANS (MANAGER)
(573) 975-3602
Entity
Organization
Contact information
Practice address
734 W MONROE ST, MEXICO, MO 65265-1970
(573) 975-3602
Mailing address
PO BOX 63, MEXICO, MO 65265-0063
(573) 975-3602
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
347E00000X
Transportation Broker
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
02/01/2019
Last updated
02/01/2019
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