Provider Demographics
NPI:1114159746
Name:AUTISM SERVICES OF THE NORTH SHORE, INC.
Entity Type:Organization
Organization Name:AUTISM SERVICES OF THE NORTH SHORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRELA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:VESA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:847-869-1505
Mailing Address - Street 1:844 HINMAN AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-5914
Mailing Address - Country:US
Mailing Address - Phone:847-869-1505
Mailing Address - Fax:
Practice Address - Street 1:844 HINMAN AVE APT 1
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-5914
Practice Address - Country:US
Practice Address - Phone:847-869-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-15
Last Update Date:2009-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009727251C00000X
IL056004090251C00000X
IL070011141251C00000X
IL146003437251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services