Provider Demographics
NPI:1528537248
Name:RADIANT AUTISM SERVICES, LLC
Entity Type:Organization
Organization Name:RADIANT AUTISM SERVICES, LLC
Other - Org Name:RADIANT AUTISM SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-773-8602
Mailing Address - Street 1:829 MAYBOLE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5118
Mailing Address - Country:US
Mailing Address - Phone:702-773-1581
Mailing Address - Fax:
Practice Address - Street 1:3810 PACKARD ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2054
Practice Address - Country:US
Practice Address - Phone:702-773-1581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty