| Name: | Avatar Residential, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 06 Sep 1991 (33 years ago) |
| Identification Number: | 000065577 |
| ZIP code: | 02886 |
| County: | Kent County |
| Principal Address: | 33 COLLEGE HILL ROAD BLDG 33, WARWICK, RI, 02886, USA |
| Purpose: | RESIDENTIAL SERVICES FOR ADULTS WITH PHYSICAL AND MENTAL DISABILITIES. |
| NAICS: | 623210 - Residential Intellectual and Developmental Disability Facilities |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053607754 | 2011-06-22 | 2011-06-22 | 33 COLLEGE HILL RD, BLDG.33, WARWICK, RI, 028862776, US | 33 COLLEGE HILL RD, BLDG.33, WARWICK, RI, 028862776, US | |||||||||||||||||||||||||
|
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| Phone | +1 401-826-7500 |
| Fax | 4018267503 |
Authorized person
| Name | KATHLEEN A ELLIS |
| Role | EXECUTIVE DIRECTOR |
| Phone | 4018267500 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| License Number | 136 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PROVIDER NUMBER |
| Number | AI54946 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| KATHLEEN ELLIS | Agent | 33 COLLEGE HILL ROAD BUILDING 33A, WARWICK, RI, 02886, USA |
| Name | Role | Address |
|---|---|---|
| KATHLEEN A. ELLIS | PRESIDENT | 243 SILVER LAKE AVE WAKEFIELD, RI 02879 USA |
| KATHLEEN A ELLIS | PRESIDENT | 33 COLLEGE HILL ROAD BLDG #33, BLDG 33 WARWICK, RI 02886 USA |
| Name | Role | Address |
|---|---|---|
| ALISSA FORLEO | VICE PRESIDENT | 40 STRATHMORE ROAD CRANSTON, RI 02905 USA |
| Number | Name | File Date |
|---|---|---|
| 202454852190 | Annual Report | 2024-05-24 |
| 202338676410 | Annual Report | 2023-06-26 |
| 202338011860 | Revocation Notice For Failure to File An Annual Report | 2023-06-19 |
| 202207908350 | Annual Report | 2022-01-12 |
| 202185946810 | Annual Report | 2021-01-12 |
| 202032095490 | Annual Report | 2020-01-13 |
| 201986944720 | Annual Report | 2019-02-19 |
| 201856186760 | Annual Report | 2018-01-16 |
| 201734135460 | Annual Report | 2017-02-15 |
| 201690976060 | Annual Report | 2016-01-20 |
Date of last update: 07 Oct 2024
Sources: Rhode Island Department of State
