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NPI Code Detail

MEDICARE: FLORIDA AUTISM CENTER

MEDICARE: FLORIDA AUTISM CENTER
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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134662307
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA AUTISM CENTER
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 45 ALABAMA AVE
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-2677
Country : US
Telephone Number : 866-610-0580
Fax Number :
Authorized Official
Title or Position : CEO
Name : JASON OWEN
Credential :
Telephone Number : 470-816-6449
Provider Enumeration Date : 11/21/2016
Last Update Date : 11/07/2022

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