Provider Demographics
NPI:1639846017
Name:INTEGRATED AUTISM CENTER LLC
Entity Type:Organization
Organization Name:INTEGRATED AUTISM CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHAVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-732-1234
Mailing Address - Street 1:43475 DALCOMA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3593
Mailing Address - Country:US
Mailing Address - Phone:586-263-1818
Mailing Address - Fax:
Practice Address - Street 1:43475 DALCOMA DR STE 208
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3593
Practice Address - Country:US
Practice Address - Phone:586-263-1818
Practice Address - Fax:586-314-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty