Provider Demographics
NPI:1710575691
Name:SPARK CENTER FOR AUTISM, LLC
Entity Type:Organization
Organization Name:SPARK CENTER FOR AUTISM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:REENA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-238-9772
Mailing Address - Street 1:24555 HALLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-1667
Mailing Address - Country:US
Mailing Address - Phone:248-238-9772
Mailing Address - Fax:844-270-6477
Practice Address - Street 1:24555 HALLWOOD CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-1667
Practice Address - Country:US
Practice Address - Phone:248-238-9772
Practice Address - Fax:844-270-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-06
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty