Provider Demographics
NPI:1629753082
Name:ALLIANCE AUTISM CENTER
Entity Type:Organization
Organization Name:ALLIANCE AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA, MST, CGMA
Authorized Official - Phone:734-513-2731
Mailing Address - Street 1:3290 W BIG BEAVER RD STE 510
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2917
Mailing Address - Country:US
Mailing Address - Phone:734-517-2731
Mailing Address - Fax:844-830-9426
Practice Address - Street 1:2901 MONATE CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1770
Practice Address - Country:US
Practice Address - Phone:734-513-2731
Practice Address - Fax:844-830-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty