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NPI Code Detail

MEDICARE: INCLUDE AUTISM, INC.

MEDICARE: INCLUDE AUTISM, INC.
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
1251C00000XDevelopmentally Disabled Services Day Training Agency
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1093041600
Entity Type Code : Organization
Provider Name (Legal Business Name) : INCLUDE AUTISM, INC.
Provider Business Mailing Address
First Line : PO BOX 720072
Second Line :
City : SAN DIEGO
State : CA
Zip : 92172-0072
Country : US
Telephone Number : 858-603-9835
Fax Number : 619-255-2739
Provider Business Practice Location Address
First Line : 625 PENNSYLVANIA AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92103-4321
Country : US
Telephone Number : 858-603-9835
Fax Number : 619-255-2739
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TINA WATERS
Credential :
Telephone Number : 858-603-9835
Provider Enumeration Date : 11/02/2009
Last Update Date : 04/24/2018

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