MEDICARE: FLORIDA AUTISM CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	251S00000X	Community/Behavioral Health Agency
4	252Y00000X	Early Intervention Provider Agency
5	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497123897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA AUTISM CENTER

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	470-816-6449
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 PALM COAST PKWY SW
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4739
Country	:	US
Telephone Number	:	386-951-3044
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JASON OWEN
Credential	:
Telephone Number	:	470-816-6449

Provider Enumeration Date	:	09/02/2015
Last Update Date	:	11/10/2022

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Directions to “FLORIDA AUTISM CENTER ” Practice Location

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