Provider Demographics
NPI:1437800604
Name:AUTISM LIVING EXPERIENCE, LLC
Entity Type:Organization
Organization Name:AUTISM LIVING EXPERIENCE, LLC
Other - Org Name:AUTISM LIVING EXPERIENCE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRYA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-400-1044
Mailing Address - Street 1:4052 RIVER BANK WAY
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33980-6515
Mailing Address - Country:US
Mailing Address - Phone:888-392-8642
Mailing Address - Fax:888-783-7611
Practice Address - Street 1:4052 RIVER BANK WAY
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33980-6515
Practice Address - Country:US
Practice Address - Phone:941-400-1044
Practice Address - Fax:888-783-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty