Provider Demographics
NPI:1851796213
Name:HOME BASED AUTISM THERAPY
Entity Type:Organization
Organization Name:HOME BASED AUTISM THERAPY
Other - Org Name:AUTISM HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEGGAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GHISHIJOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-330-9846
Mailing Address - Street 1:158 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2260
Mailing Address - Country:US
Mailing Address - Phone:774-330-9846
Mailing Address - Fax:
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2260
Practice Address - Country:US
Practice Address - Phone:774-330-9846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1-10-7244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty