Healthcare Provider Details

I. General information

NPI: 1902046725
Provider Name (Legal Business Name): THE RICH CENTER FOR AUTISM @YSU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE UNIVERSITY PLAZA
YOUNGSTOWN OH
44555
US

IV. Provider business mailing address

ONE UNIVERSITY PLAZA
YOUNGSTOWN OH
44555
US

V. Phone/Fax

Practice location:
  • Phone: 330-941-1927
  • Fax: 330-941-4670
Mailing address:
  • Phone: 330-941-1927
  • Fax: 330-941-4670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-05585
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP8310
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number294860851
License Number StateOH

VIII. Authorized Official

Name: MS. J. GEORGIA BACKUS
Title or Position: DIRECTOR
Credential:
Phone: 330-941-4669