Provider Demographics
NPI:1821794363
Name:AUTISM SPECTRUM CONNECTION
Entity Type:Organization
Organization Name:AUTISM SPECTRUM CONNECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:C
Authorized Official - Last Name:FROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-336-0324
Mailing Address - Street 1:2400 E KATELLA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-5945
Mailing Address - Country:US
Mailing Address - Phone:714-336-0324
Mailing Address - Fax:
Practice Address - Street 1:333 CITY BLVD W FL 17
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-5905
Practice Address - Country:US
Practice Address - Phone:714-707-2805
Practice Address - Fax:949-534-6756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty