Healthcare Provider Details

I. General information

NPI: 1124570304
Provider Name (Legal Business Name): AUTISM SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAPLE ST FL 2
SPRINGFIELD MA
01103-1951
US

IV. Provider business mailing address

20 MAPLE ST FL 2
SPRINGFIELD MA
01103-1951
US

V. Phone/Fax

Practice location:
  • Phone: 413-209-8866
  • Fax: 413-285-8152
Mailing address:
  • Phone: 413-209-8866
  • Fax: 413-285-8152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH NGARUIYA
Title or Position: CEO
Credential:
Phone: 413-231-8313