Provider Demographics
NPI:1235816406
Name:HOUSE OF AUTISM PROPERTIES
Entity Type:Organization
Organization Name:HOUSE OF AUTISM PROPERTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SOROUR
Authorized Official - Middle Name:
Authorized Official - Last Name:REZVANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:669-222-0692
Mailing Address - Street 1:4685 ALBANY CIR APT 142
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4685 ALBANY CIR APT 142
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1131
Practice Address - Country:US
Practice Address - Phone:669-222-0692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health