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NPI Code Detail

MEDICARE: AUTISM SERVICES FOR KIDS, LLC

MEDICARE: AUTISM SERVICES FOR KIDS, LLC
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
1251S00000XCommunity/Behavioral Health Agency
2253Z00000XIn Home Supportive Care Agency
3252Y00000XEarly Intervention Provider Agency
4251C00000XDevelopmentally Disabled Services Day Training Agency

General Provider Information

NPI Number : 1528359353
Entity Type Code : Organization
Provider Name (Legal Business Name) : AUTISM SERVICES FOR KIDS, LLC
Provider Business Mailing Address
First Line : 2623 PRINCETON RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-4313
Country : US
Telephone Number : 216-233-4231
Fax Number :
Provider Business Practice Location Address
First Line : 2623 PRINCETON RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-4313
Country : US
Telephone Number : 216-233-4231
Fax Number :
Authorized Official
Title or Position : BEHAVIOR CONSULTANT
Name : KATE VANDERPLOUGH
Credential :
Telephone Number : 216-233-4231
Provider Enumeration Date : 04/27/2011
Last Update Date : 06/02/2011

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