MEDICARE: AUTISM RESPITE PLUS, 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
1	385H00000X	Respite Care

General Provider Information

NPI Number	:	1720897143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUTISM RESPITE PLUS, LLC

Provider Business Mailing Address
First Line	:	3602 LINDHOLM RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3602 LINDHOLM RD
Second Line	:
City	:	SHAKER HTS
State	:	OH
Zip	:	44120-5127
Country	:	US
Telephone Number	:	216-482-0082
Fax Number	:

Authorized Official
Title or Position	:	CEO/DOO
Name	:	MRS. SHERICE BAILEY
Credential	:
Telephone Number	:	216-482-0082

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	12/31/2024

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