Provider Demographics
NPI:1497471478
Name:BLUE AUTISM SERVICES LLC
Entity Type:Organization
Organization Name:BLUE AUTISM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:VIVEK
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-439-1032
Mailing Address - Street 1:836 PECAN TREE LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7010
Mailing Address - Country:US
Mailing Address - Phone:609-439-1032
Mailing Address - Fax:
Practice Address - Street 1:836 PECAN TREE LN
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7010
Practice Address - Country:US
Practice Address - Phone:609-439-1032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational MedicineGroup - Multi-Specialty