Provider Demographics
NPI:1720424948
Name:POLY-MODAL LEARNING FOR ASD YOUTH, INC
Entity Type:Organization
Organization Name:POLY-MODAL LEARNING FOR ASD YOUTH, INC
Other - Org Name:PLAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LEONORA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SALADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-559-7529
Mailing Address - Street 1:4600 EL CAMINO REAL
Mailing Address - Street 2:STE#211
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1374
Mailing Address - Country:US
Mailing Address - Phone:650-559-7529
Mailing Address - Fax:888-893-8780
Practice Address - Street 1:4600 EL CAMINO REAL
Practice Address - Street 2:STE#211
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1374
Practice Address - Country:US
Practice Address - Phone:650-559-7529
Practice Address - Fax:888-893-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health