Provider Demographics
NPI:1093597726
Name:AUTISM CENTERS OF UTAH, LLC
Entity Type:Organization
Organization Name:AUTISM CENTERS OF UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-770-7121
Mailing Address - Street 1:1239 E NEWPORT CENTER DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-7711
Mailing Address - Country:US
Mailing Address - Phone:754-444-3707
Mailing Address - Fax:754-600-1967
Practice Address - Street 1:1243 GAMBEL OAK WAY
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-1579
Practice Address - Country:US
Practice Address - Phone:561-866-2097
Practice Address - Fax:754-600-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty