Healthcare Provider Details

I. General information

NPI: 1972030724
Provider Name (Legal Business Name): AUTISM SYSTEMS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 KEEWAHDIN RD
FORT GRATIOT MI
48059-3498
US

IV. Provider business mailing address

5039 VILLA LINDE PKWY STE 30
FLINT MI
48532-3450
US

V. Phone/Fax

Practice location:
  • Phone: 989-401-2244
  • Fax: 800-562-3347
Mailing address:
  • Phone: 248-228-0502
  • Fax: 800-562-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-79
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RUCHI BHARDWAJ
Title or Position: OWNER
Credential:
Phone: 248-228-0502