Provider Demographics
NPI:1790212900
Name:THE INSTITUTE OF AUTISM AND NEURODEVELOPMENT
Entity Type:Organization
Organization Name:THE INSTITUTE OF AUTISM AND NEURODEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHADDICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, PSYD MS
Authorized Official - Phone:702-931-8990
Mailing Address - Street 1:695 TALL ARROW AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-1301
Mailing Address - Country:US
Mailing Address - Phone:702-931-8990
Mailing Address - Fax:
Practice Address - Street 1:8350 W SAHARA AVE STE 130
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8940
Practice Address - Country:US
Practice Address - Phone:702-931-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0276261QM0801X
NVNV20171307801261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1073951786Medicaid