Provider Demographics
NPI:1871911172
Name:AVENUE MEDICAL CONSTRUCTION LLC
Entity type:Organization
Organization Name:AVENUE MEDICAL CONSTRUCTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:ATP, CAPS
Authorized Official - Phone:302-674-0907
Mailing Address - Street 1:243 QUIGLEY BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4191
Mailing Address - Country:US
Mailing Address - Phone:302-674-0907
Mailing Address - Fax:302-674-1421
Practice Address - Street 1:243 QUIGLEY BLVD STE J
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4191
Practice Address - Country:US
Practice Address - Phone:302-674-0907
Practice Address - Fax:302-674-1421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2007602801171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty