Healthcare Provider Details

I. General information

NPI: 1265165930
Provider Name (Legal Business Name): AVITA HOPE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 SUMMIT AVENUE SUITE 101
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

591 SUMMIT AVENUE SUITE 101
JERSEY CITY NJ
07306
US

V. Phone/Fax

Practice location:
  • Phone: 201-300-0160
  • Fax: 201-300-0165
Mailing address:
  • Phone: 201-300-0160
  • Fax: 201-300-0165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LOU TURDO
Title or Position: CEO
Credential:
Phone: 201-300-0160