Provider Demographics
NPI:1619144953
Name:ALTA VISTA CENTER FOR AUTISM
Entity Type:Organization
Organization Name:ALTA VISTA CENTER FOR AUTISM
Other - Org Name:DBA FIREFLY AUTISM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WINN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:303-759-1192
Mailing Address - Street 1:2001 HOYT ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1639
Mailing Address - Country:US
Mailing Address - Phone:303-759-1192
Mailing Address - Fax:303-759-1194
Practice Address - Street 1:2001 HOYT ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1639
Practice Address - Country:US
Practice Address - Phone:303-759-1192
Practice Address - Fax:303-759-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 385H00000X
CO1531305252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17770106Medicaid