Provider Demographics
NPI:1740207422
Name:AUTISTIC TREATMENT CENTER, INC.
Entity Type:Organization
Organization Name:AUTISTIC TREATMENT CENTER, INC.
Other - Org Name:AUTISM TREATMENT CENTER REHABILITATION AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:PENN
Authorized Official - Last Name:HUNDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-644-2076
Mailing Address - Street 1:10503 METRIC DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-5514
Mailing Address - Country:US
Mailing Address - Phone:972-644-2076
Mailing Address - Fax:972-644-5650
Practice Address - Street 1:15911 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-1107
Practice Address - Country:US
Practice Address - Phone:210-599-7733
Practice Address - Fax:210-599-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181437801Medicaid
TX676629Medicare PIN
TX181437801Medicaid