Healthcare Provider Details

I. General information

NPI: 1306637111
Provider Name (Legal Business Name): MOUNTAINTOP AUTISM PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 NEEDLE CREEK RD
DIVIDE CO
80814-8115
US

IV. Provider business mailing address

175 NEEDLE CREEK RD
DIVIDE CO
80814-8115
US

V. Phone/Fax

Practice location:
  • Phone: 703-789-5660
  • Fax:
Mailing address:
  • Phone: 703-789-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: REED NELSON
Title or Position: OWNER
Credential:
Phone: 703-789-5660