Provider Demographics
NPI:1508438219
Name:ARBOR AUTISM CENTERS ALLIED HEALTH LLC
Entity Type:Organization
Organization Name:ARBOR AUTISM CENTERS ALLIED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-657-1470
Mailing Address - Street 1:1400 HATCHER CRES
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-2426
Mailing Address - Country:US
Mailing Address - Phone:734-657-1470
Mailing Address - Fax:734-527-5981
Practice Address - Street 1:1400 HATCHER CRES
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-2426
Practice Address - Country:US
Practice Address - Phone:734-657-1470
Practice Address - Fax:734-527-5981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARBOR AUTISM CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1225321763OtherTYPE 1 NPI
MI7101003147OtherMI LARA SLP LICENSE
MI5201010302OtherMI LARA OT LICENSE
1770068579OtherTYPE 1 NPI