Provider Demographics
NPI:1649673427
Name:BRANDYWINE CENTER FOR AUTISM, LLC
Entity type:Organization
Organization Name:BRANDYWINE CENTER FOR AUTISM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:302-762-2636
Mailing Address - Street 1:510 PHILADELPHIA PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2100
Mailing Address - Country:US
Mailing Address - Phone:302-575-9702
Mailing Address - Fax:302-348-9028
Practice Address - Street 1:510 PHILADELPHIA PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-2100
Practice Address - Country:US
Practice Address - Phone:302-575-9702
Practice Address - Fax:302-348-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 251S00000X
DE2014605224252Y00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency