Healthcare Provider Details

I. General information

NPI: 1225223126
Provider Name (Legal Business Name): ALPINE AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
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:
Mailing address:
  • Phone: 719-203-6903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number1546288
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number1546288
License Number StateCO

VIII. Authorized Official

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