Provider Demographics
NPI:1174110761
Name:AVATAR RESIDENTIAL DETOX CENTER INC
Entity type:Organization
Organization Name:AVATAR RESIDENTIAL DETOX CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PINAL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-464-5062
Mailing Address - Street 1:2 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 MORRIS RD
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-1700
Practice Address - Country:US
Practice Address - Phone:973-464-5062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility