MEDICARE: AURTISM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1558922021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AURTISM

Provider Business Mailing Address
First Line	:	609 W ADAMS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3322
Country	:	US
Telephone Number	:	702-612-8804
Fax Number	:

Provider Business Practice Location Address
First Line	:	609 W ADAMS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3322
Country	:	US
Telephone Number	:	702-612-8804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	COURTNEY HAYWOOD
Credential	:
Telephone Number	:	702-805-3536

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	03/10/2020

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