1275691321 NPI number — AUTISM SERVICES, INCORPORATED

Table of content: (NPI 1275691321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275691321 NPI number — AUTISM SERVICES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTISM SERVICES, INCORPORATED
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:
1275691321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 CORPORATION PKWY
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27610-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-255-9011
Provider Business Mailing Address Fax Number:
919-255-9029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 DICKENS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27610-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-250-1907
Provider Business Practice Location Address Fax Number:
919-250-0907
Provider Enumeration Date:
12/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
ALTON
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
919-255-6011

Provider Taxonomy Codes

  • Taxonomy code: 320900000X , with the licence number:  092104 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 340602G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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