Healthcare Provider Details

I. General information

NPI: 1427559798
Provider Name (Legal Business Name): AUTISM COMMUNITY SUPPORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 EAST EVANS AVE 90A
DENVER CO
80247-3557
US

IV. Provider business mailing address

10001 EAST EVANS AVE 90A
DENVER CO
80247-3557
US

V. Phone/Fax

Practice location:
  • Phone: 719-217-1134
  • Fax:
Mailing address:
  • Phone: 719-217-1134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TINA DOBSON
Title or Position: OWNER
Credential:
Phone: 719-217-1134