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General NPI Number Information
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NPI Number | 1972646800
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Entity Type | Organization
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Legal Business Name | AUTISM SERVICES CENTER
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 10 6TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-0028
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Country | US
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Telephone | 304-525-8014
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Fax | 304-525-8026
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Provider Business Mailing Address
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Address Line | 10 6TH AVE W
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City | HUNTINGTON
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State | WV
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Zip | 25701-0028
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Country | US
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Telephone | 304-525-8014
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Fax | 304-525-8026
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Authorized Official
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Title or Position | CEO
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Name | DR. JIMMIE DAVID BEIRNE
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Credential | PH.D & BCBA-D
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Telephone | 304-525-8014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 35
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License Number State | WV
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