Provider Demographics
NPI:1902408297
Name:KEYSTONE AUTISM SOLUTIONS LLC
Entity Type:Organization
Organization Name:KEYSTONE AUTISM SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-430-8285
Mailing Address - Street 1:3507 W CAPILANO DR
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-8879
Mailing Address - Country:US
Mailing Address - Phone:765-430-8285
Mailing Address - Fax:
Practice Address - Street 1:933 S STATE ROAD 57 STE B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4374
Practice Address - Country:US
Practice Address - Phone:765-430-8285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty