1376660043 NPI number — AVATAR RESIDENTIAL INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376660043 NPI number — AVATAR RESIDENTIAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVATAR RESIDENTIAL INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376660043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 COLLEGE HILL RD
Provider Second Line Business Mailing Address:
BUILDING 33
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-826-7500
Provider Business Mailing Address Fax Number:
401-826-7503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 LILLIAN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02920-6200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-942-0720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
401-826-7500

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  254 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA25880 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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