Provider Demographics
NPI:1356863229
Name:QUALITY AUTISM CARE
Entity Type:Organization
Organization Name:QUALITY AUTISM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:BRATTON
Authorized Official - Last Name:GAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MMFT, BCBA
Authorized Official - Phone:864-490-1668
Mailing Address - Street 1:123 DUNNSMORE DR
Mailing Address - Street 2:
Mailing Address - City:INMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29349-7210
Mailing Address - Country:US
Mailing Address - Phone:864-490-1668
Mailing Address - Fax:
Practice Address - Street 1:123 DUNNSMORE DR
Practice Address - Street 2:
Practice Address - City:INMAN
Practice Address - State:SC
Practice Address - Zip Code:29349-7210
Practice Address - Country:US
Practice Address - Phone:864-490-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-15-21097253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
13945091OtherCAQH
SCBA1026Medicaid
1093174096OtherPERSONAL NPI