Provider Demographics
NPI:1235913914
Name:AUTISM LIFE CARE CENTER, LLC
Entity Type:Organization
Organization Name:AUTISM LIFE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-405-4674
Mailing Address - Street 1:11558 FREMANTLE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2636
Mailing Address - Country:US
Mailing Address - Phone:513-405-4674
Mailing Address - Fax:
Practice Address - Street 1:11558 FREMANTLE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2636
Practice Address - Country:US
Practice Address - Phone:513-405-4674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center