Provider Demographics
NPI:1447333463
Name:AVANTE AT LYNCHBURG, INC.
Entity type:Organization
Organization Name:AVANTE AT LYNCHBURG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-987-7180
Mailing Address - Street 1:4601 SHERIDAN STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3439
Mailing Address - Country:US
Mailing Address - Phone:434-846-8437
Mailing Address - Fax:434-846-4032
Practice Address - Street 1:2081 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1443
Practice Address - Country:US
Practice Address - Phone:434-846-8437
Practice Address - Fax:434-846-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2490314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4951514Medicaid
VA4960521Medicaid
VA4960521Medicaid