Provider Demographics
NPI:1144776287
Name:AUTISM AND DEVELOPMENTAL INTERVENTION SERVICES, INC.
Entity Type:Organization
Organization Name:AUTISM AND DEVELOPMENTAL INTERVENTION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:714-472-3660
Mailing Address - Street 1:23811 WASHINGTON AVE C110-296
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2267
Mailing Address - Country:US
Mailing Address - Phone:714-472-3660
Mailing Address - Fax:951-304-0390
Practice Address - Street 1:23811 WASHINGTON AVE C110-296
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-2267
Practice Address - Country:US
Practice Address - Phone:714-472-3660
Practice Address - Fax:951-304-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty