Healthcare Provider Details

I. General information

NPI: 1275001828
Provider Name (Legal Business Name): RIPPLE EFFECTS AUTISM LEARNING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

06321 BLUE STAR MEMORIAL HWY
SOUTH HAVEN MI
49090-7775
US

IV. Provider business mailing address

9825 PINE VIEW DR
PORTAGE MI
49002-7055
US

V. Phone/Fax

Practice location:
  • Phone: 859-553-2472
  • Fax:
Mailing address:
  • Phone: 859-553-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CAVALLI
Title or Position: OWNER
Credential: BCBA
Phone: 859-553-2472