MEDICARE: CALIFORNIA AUTISM CENTER, 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
1	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1871915678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA AUTISM CENTER, INC.

Provider Business Mailing Address
First Line	:	5132 N PALM AVE
Second Line	:	BOX #303
City	:	FRESNO
State	:	CA
Zip	:	93704-2236
Country	:	US
Telephone Number	:	559-385-5858
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 W. SHAW AVE
Second Line	:	SUITE 190
City	:	FRESNO
State	:	CA
Zip	:	93710-8114
Country	:	US
Telephone Number	:	559-492-7900
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICE
Name	:	MR. WILLIAM FORATH
Credential	:
Telephone Number	:	559-492-7900

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	06/18/2021

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