Provider Demographics
NPI:1437608023
Name:AVITA ALTERNATIVE SOLUTIONS FOR LIFE
Entity Type:Organization
Organization Name:AVITA ALTERNATIVE SOLUTIONS FOR LIFE
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-344-9643
Mailing Address - Street 1:14 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2619
Mailing Address - Country:US
Mailing Address - Phone:201-344-9643
Mailing Address - Fax:
Practice Address - Street 1:14 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2619
Practice Address - Country:US
Practice Address - Phone:201-344-9643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder