Healthcare Provider Details

I. General information

NPI: 1053209056
Provider Name (Legal Business Name): ALPINE AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 FIELDSTONE RD
COLORADO SPRINGS CO
80919-3100
US

IV. Provider business mailing address

2760 FIELDSTONE RD
COLORADO SPRINGS CO
80919-3100
US

V. Phone/Fax

Practice location:
  • Phone: 719-203-6903
  • Fax: 719-203-6904
Mailing address:
  • Phone: 719-203-6903
  • Fax: 719-203-6904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: AARON CRUM
Title or Position: BILLING MANAGER
Credential:
Phone: 719-203-6903