Provider Demographics
NPI:1356508030
Name:COMPREHENSIVE AUTISM CENTER, INC,
Entity Type:Organization
Organization Name:COMPREHENSIVE AUTISM CENTER, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:951-813-4034
Mailing Address - Street 1:40485 MURRIETA HOT SPRINGS RD
Mailing Address - Street 2:B-4, #146
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6436
Mailing Address - Country:US
Mailing Address - Phone:951-813-4034
Mailing Address - Fax:
Practice Address - Street 1:41951 REMINGTON AVE
Practice Address - Street 2:STE 210
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2552
Practice Address - Country:US
Practice Address - Phone:951-813-4034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty