Provider Demographics
NPI:1225813678
Name:AUTISM REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:AUTISM REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-250-0984
Mailing Address - Street 1:3603 COLONY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1801
Mailing Address - Country:US
Mailing Address - Phone:915-250-0984
Mailing Address - Fax:
Practice Address - Street 1:3603 COLONY RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1801
Practice Address - Country:US
Practice Address - Phone:915-250-0984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty