Organization
AVATAR RESIDENTIAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN A ELLIS (EXECUTIVE DIRECTOR)
(401) 826-7500
Entity
Organization
Contact information
Practice address
33 COLLEGE HILL RD, BLDG.33, WARWICK, RI 02886-2776
(401) 826-7500
(401) 826-7503
Mailing address
33 COLLEGE HILL RD, BLDG.33, WARWICK, RI 02886-2776
(401) 826-7500
(401) 826-7503
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
136
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AI54946
PROVIDER NUMBER
RI
Enumeration date
06/22/2011
Last updated
06/22/2011
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