MEDICARE: AUTISM LIVING EXPERIENCE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	103T00000X	Psychologist
4	106S00000X	Behavior Technician
5	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1437800604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM LIVING EXPERIENCE, LLC

Provider Business Mailing Address
First Line	:	1990 MAIN ST STE 750
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34236-8000
Country	:	US
Telephone Number	:	888-392-8642
Fax Number	:	888-783-7611

Provider Business Practice Location Address
First Line	:	4052 RIVER BANK WAY
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33980-6515
Country	:	US
Telephone Number	:	941-400-1044
Fax Number	:	888-783-7611

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	TODD STUCKEY
Credential	:
Telephone Number	:	888-392-8642

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	03/09/2026

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