Provider Demographics
| NPI: | 1609156413 |
|---|---|
| Name: | ACADEMY FOR THE ADVANCEMENT OF CHILDREN WITH AUTISM |
| Entity Type: | Organization |
| Organization Name: | ACADEMY FOR THE ADVANCEMENT OF CHILDREN WITH AUTISM |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MS |
| Authorized Official - First Name: | LESLIE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | GHRIST |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 818-882-0200 |
| Mailing Address - Street 1: | 4083 W AVENUE L # 344 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LANCASTER |
| Mailing Address - State: | CA |
| Mailing Address - Zip Code: | 93536-4202 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 818-882-0200 |
| Mailing Address - Fax: | 818-882-0206 |
| Practice Address - Street 1: | 10824 TOPANGA CANYON BLVD |
| Practice Address - Street 2: | |
| Practice Address - City: | CHATSWORTH |
| Practice Address - State: | CA |
| Practice Address - Zip Code: | 91311-1350 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 818-882-0200 |
| Practice Address - Fax: | 818-882-0206 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-08-24 |
| Last Update Date: | 2011-08-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| CA | 2703 | 103TS0200X |
| CA | 2847 | 103TS0200X |
| CA | 34327 | 225100000X, 2251G0304X, 2251P0200X, 2251X0800X |
| CA | 6659 | 225X00000X, 225XF0002X, 225XN1300X, 225XP0019X, 225XP0200X |
| CA | 1920 | 231H00000X |
| CA | 1032 | 2355S0801X |
| CA | 4999 | 235Z00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 225XF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Feeding, Eating & Swallowing | Group - Multi-Specialty |
| No | 225XN1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Neurorehabilitation | Group - Multi-Specialty |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
| No | 225XP0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics | Group - Multi-Specialty |
| No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
