Provider Demographics
NPI:1801937461
Name:AVATAR, INC.
Entity type:Organization
Organization Name:AVATAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-392-7485
Mailing Address - Street 1:4042 PACIFIC AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-1689
Mailing Address - Country:US
Mailing Address - Phone:801-392-7485
Mailing Address - Fax:
Practice Address - Street 1:4042 PACIFIC AVE STE 3
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-1689
Practice Address - Country:US
Practice Address - Phone:801-392-7485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTA00815320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities