MEDICARE: ACE- AUTISM CENTER FOR ENRICHMENT

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	251S00000X	Community/Behavioral Health Agency	1-06-2999	IN

General Provider Information

NPI Number	:	1083067078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACE- AUTISM CENTER FOR ENRICHMENT

Provider Business Mailing Address
First Line	:	8328 MASTERS RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1538
Country	:	US
Telephone Number	:	317-436-7080
Fax Number	:	317-436-7225

Provider Business Practice Location Address
First Line	:	8328 MASTERS RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1538
Country	:	US
Telephone Number	:	317-436-7080
Fax Number	:	317-436-7225

Authorized Official
Title or Position	:	FOUNDER, PREESIDENT & CEO
Name	:	KELSEY MARISA PUMEL
Credential	:	M.A.
Telephone Number	:	317-436-7080

Provider Enumeration Date	:	07/14/2016
Last Update Date	:	07/14/2016

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