Healthcare Provider Details

I. General information

NPI: 1144756750
Provider Name (Legal Business Name): ASPIRE AUTISM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GARDEN CTR
BROOMFIELD CO
80020-7314
US

IV. Provider business mailing address

505 N. BRAND BLVD SUITE 1000
GLENDALE CA
91203
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-6780
  • Fax: 818-241-6853
Mailing address:
  • Phone: 818-241-6780
  • Fax: 818-241-6853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY P. WINTER
Title or Position: PRESIDENT & CEO
Credential:
Phone: 818-241-6780