1881864916 NPI number — AUTISM SERVICES NORTH

Table of content: (NPI 1881864916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881864916 NPI number — AUTISM SERVICES NORTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTISM SERVICES NORTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881864916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 N. BRAND BLVD
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-295-3276
Provider Business Mailing Address Fax Number:
818-241-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 CUMBERLAND PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 316
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-306-8602
Provider Business Practice Location Address Fax Number:
818-241-6853
Provider Enumeration Date:
03/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RUSSELL
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
C.F.O.
Authorized Official Telephone Number:
818-241-6780

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 1-00-0010 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103K00000X , with the licence number: 1-04-1754 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)