Provider Demographics
NPI:1083208458
Name:KINGZ COURT AUTISM CENTER
Entity Type:Organization
Organization Name:KINGZ COURT AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEROMY
Authorized Official - Middle Name:JERELL
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-501-6730
Mailing Address - Street 1:190 SUNDERLAND CIR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30215-5253
Mailing Address - Country:US
Mailing Address - Phone:609-501-6730
Mailing Address - Fax:
Practice Address - Street 1:190 SUNDERLAND CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-5253
Practice Address - Country:US
Practice Address - Phone:609-501-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINGZ COURT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-25
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty