| Organization Name: | AVANTE GARDE HEALTH CENTERS, LLC |
| NPI Number: | 1407125016 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA Y CUNDIFF-ROY (OWNER) |
| Mailing Address: | 72 Joe T Pettey Dr Suite B Russell Springs |
| State: | KY US |
| Postal Code: | 42642 |
| Phone Number: | 2708664357 |
| Fax Number: | 2708584957 |
| NPI Enumeration Date: | 12/28/2011 |
| NPI Last Update Date: | 12/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |