Healthcare Provider Details

I. General information

NPI: 1295070464
Provider Name (Legal Business Name): AUTISM SERVICES NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 11/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 TANNERY RD
DILLSBURG PA
17019-9673
US

IV. Provider business mailing address

39 TANNERY RD
DILLSBURG PA
17019-9673
US

V. Phone/Fax

Practice location:
  • Phone: 800-306-8650
  • Fax: 866-206-8602
Mailing address:
  • Phone: 800-306-8650
  • Fax: 866-206-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: LISA GIBBNER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 800-306-8602