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AVALON HOSPICE

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Company Details

Name: AVALON HOSPICE
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 10 Feb 2016 (9 years ago)
Entity Number: 557344
Place of Formation: IDAHO
File Number: 0000557344
ZIP code: 83401
County: Bonneville County
Mailing Address: 403 1ST ST IDAHO FALLS, ID 83401

National Provider Identifier

NPI Number:
1497031421

Authorized Person:

Name:
MR. JACOB RAYMOND BRYAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
251G00000X - Community Based Hospice Care Agency
Is Primary:
Yes

Contacts:

Fax:
2084190974

Filing

Filing Name Filing Number Filing date
Initial Filing 0000557344 2016-02-10

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State