Provider Demographics
NPI:1275691321
Name:AUTISM SERVICES, INCORPORATED
Entity Type:Organization
Organization Name:AUTISM SERVICES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:BASS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MS
Authorized Official - Phone:919-255-6011
Mailing Address - Street 1:1310 CORPORATION PKWY
Mailing Address - Street 2:SUITE H
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1363
Mailing Address - Country:US
Mailing Address - Phone:919-255-9011
Mailing Address - Fax:919-255-9029
Practice Address - Street 1:113 DICKENS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-2424
Practice Address - Country:US
Practice Address - Phone:919-250-1907
Practice Address - Fax:919-250-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC092104320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC340602GMedicaid