Provider Demographics
NPI:1366692279
Name:ALEXANDER LEIGH CENTER FOR AUTISM
Entity Type:Organization
Organization Name:ALEXANDER LEIGH CENTER FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-458-6802
Mailing Address - Street 1:9109 TRINITY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-1668
Mailing Address - Country:US
Mailing Address - Phone:847-458-6802
Mailing Address - Fax:
Practice Address - Street 1:9109 TRINITY DR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-1668
Practice Address - Country:US
Practice Address - Phone:847-458-6802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-27
Last Update Date:2008-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health