Provider Demographics
NPI:1720486376
Name:AUTISM SOCIETY OF INDIANA
Entity Type:Organization
Organization Name:AUTISM SOCIETY OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE ALLY
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RENAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-609-8449
Mailing Address - Street 1:3951 N MERIDIAN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4057
Mailing Address - Country:US
Mailing Address - Phone:800-609-8449
Mailing Address - Fax:
Practice Address - Street 1:3951 N MERIDIAN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4057
Practice Address - Country:US
Practice Address - Phone:800-609-8449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable