Provider Demographics
NPI:1447016563
Name:AVESTA CARE MEDICAL STAFFING, LLC
Entity type:Organization
Organization Name:AVESTA CARE MEDICAL STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-351-9684
Mailing Address - Street 1:1705 PLATT PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7762
Mailing Address - Country:US
Mailing Address - Phone:334-351-9684
Mailing Address - Fax:334-694-0422
Practice Address - Street 1:1705 PLATT PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7762
Practice Address - Country:US
Practice Address - Phone:334-351-9684
Practice Address - Fax:334-694-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service