Provider Demographics
NPI:1528540259
Name:CENTER FOR AUTISM AND RELATED DISORDERS LLC
Entity Type:Organization
Organization Name:CENTER FOR AUTISM AND RELATED DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD INSURANCE CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-2345
Mailing Address - Street 1:21600 OXNARD ST STE 1800
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-7807
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:818-758-8015
Practice Address - Street 1:10015 OLD COLUMBIA RD STE F100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1755
Practice Address - Country:US
Practice Address - Phone:443-741-8788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR AUTISM AND RELATED DISORDERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD724002300Medicaid