Provider Demographics
NPI:1134509896
Name:GOT-AUTISM, LLC
Entity Type:Organization
Organization Name:GOT-AUTISM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:LUCILLE
Authorized Official - Last Name:ANDERSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-881-6363
Mailing Address - Street 1:10052 COMMERCE PARK DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1334
Mailing Address - Country:US
Mailing Address - Phone:513-881-6363
Mailing Address - Fax:513-881-7010
Practice Address - Street 1:10052 COMMERCE PARK DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45246-1334
Practice Address - Country:US
Practice Address - Phone:513-881-6363
Practice Address - Fax:513-881-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM092803OtherMEDICAID WAIVER