Healthcare Provider Details

I. General information

NPI: 1235913914
Provider Name (Legal Business Name): AUTISM LIFE CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11558 FREMANTLE DR
CINCINNATI OH
45240-2636
US

IV. Provider business mailing address

11558 FREMANTLE DR
CINCINNATI OH
45240-2636
US

V. Phone/Fax

Practice location:
  • Phone: 513-405-4674
  • Fax:
Mailing address:
  • Phone: 513-405-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARLA WILLIAMS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 513-405-4674