Provider Demographics
NPI:1184006041
Name:AUTISM CARE WEST LLC
Entity Type:Organization
Organization Name:AUTISM CARE WEST LLC
Other - Org Name:AUTISM CARE WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, BEHAVIOR ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARRIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, BCBA, LBA
Authorized Official - Phone:702-326-5996
Mailing Address - Street 1:2500 CITRUS GARDEN CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2387
Mailing Address - Country:US
Mailing Address - Phone:702-326-5996
Mailing Address - Fax:702-912-4662
Practice Address - Street 1:2500 CITRUS GARDEN CIR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2387
Practice Address - Country:US
Practice Address - Phone:702-326-5996
Practice Address - Fax:702-912-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0048103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty