Provider Demographics
NPI:1740437029
Name:CENTER FOR AUTISM AND RELATED DISORDERS LLC
Entity type:Organization
Organization Name:CENTER FOR AUTISM AND RELATED DISORDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD INSURANCE CONTRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-345-2345
Mailing Address - Street 1:940 SARATOGA AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3409
Mailing Address - Country:US
Mailing Address - Phone:408-423-8076
Mailing Address - Fax:
Practice Address - Street 1:3610 SNELL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136
Practice Address - Country:US
Practice Address - Phone:408-618-5265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR AUTISM AND RELATED DISORDERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-19
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA0-08-2463251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty