1629753082 NPI number — ALLIANCE AUTISM CENTER

Table of content: (NPI 1629753082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629753082 NPI number — ALLIANCE AUTISM CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE AUTISM CENTER
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:
1629753082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3290 W BIG BEAVER RD STE 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48084-2917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-517-2731
Provider Business Mailing Address Fax Number:
844-830-9426

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 MONATE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89044-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-513-2731
Provider Business Practice Location Address Fax Number:
844-830-9426
Provider Enumeration Date:
06/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SUAN
Authorized Official First Name:
WILMAR
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
734-513-2731

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com