Provider Demographics
NPI:1720204191
Name:BALANCE AUTSIM
Entity Type:Organization
Organization Name:BALANCE AUTSIM
Other - Org Name:THE HOMESTEAD AUTISM SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-957-3342
Mailing Address - Street 1:8272 NE UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:IA
Mailing Address - Zip Code:50327-8030
Mailing Address - Country:US
Mailing Address - Phone:515-967-4369
Mailing Address - Fax:515-957-3380
Practice Address - Street 1:1625 ADVENTURELAND DR STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2237
Practice Address - Country:US
Practice Address - Phone:515-957-3342
Practice Address - Fax:515-957-3380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0746768Medicaid