Provider Demographics
NPI:1750165437
Name:THE GRACIE V. WHITE FOUNDATION FOR AUTISM
Entity type:Organization
Organization Name:THE GRACIE V. WHITE FOUNDATION FOR AUTISM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:SOCIAL WORKER
Authorized Official - Phone:614-620-4273
Mailing Address - Street 1:4503 BLUE LARGO CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2091
Mailing Address - Country:US
Mailing Address - Phone:614-620-4273
Mailing Address - Fax:
Practice Address - Street 1:4503 BLUE LARGO CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2091
Practice Address - Country:US
Practice Address - Phone:614-620-4273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services