Organization
AVONDALE HEALTH SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TREVOR ANTHONY WALDEMAR MBA (VICE PRESIDENT)
(404) 294-0203
Entity
Organization
Contact information
Practice address
3508 KENSINGTON RD, DECATUR, GA 30032-1328
(404) 294-0203
(404) 294-0208
Mailing address
3508 KENSINGTON RD, DECATUR, GA 30032-1328
(404) 294-0203
(404) 294-0208
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
00483931A
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028513A
—
GA
05
—
300028513B
—
GA
Enumeration date
10/01/2010
Last updated
10/01/2010
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