MEDICARE: AUTISM HOME SUPPORT SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	11520828	IL

General Provider Information

NPI Number	:	1043677891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM HOME SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	2285 S LEXINGTON DR
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-5899
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2285 S LEXINGTON DR
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-5899
Country	:	US
Telephone Number	:	708-625-6134
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	BRANDI BROWN
Credential	:	BCBA
Telephone Number	:	708-625-6134

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	01/25/2016

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Directions to “AUTISM HOME SUPPORT SERVICES ” Practice Location

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