Healthcare Provider Details

I. General information

NPI: 1770818841
Provider Name (Legal Business Name): AUTISM HOME SUPPORT SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 REVERE DR STE AA
NORTHBROOK IL
60062-8001
US

IV. Provider business mailing address

PO BOX 639561
CINCINNATI OH
45263-9561
US

V. Phone/Fax

Practice location:
  • Phone: 844-247-7222
  • Fax: 847-584-2604
Mailing address:
  • Phone: 844-247-7222
  • Fax: 847-584-2604

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
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JULIE BUSH
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 847-584-2604