Provider Demographics
NPI:1750549770
Name:MEA'ALOFA AUTISM SUPPORT CENTER
Entity type:Organization
Organization Name:MEA'ALOFA AUTISM SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERITH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-465-3933
Mailing Address - Street 1:4016 RAINTREE RD
Mailing Address - Street 2:SUITE 220B
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3700
Mailing Address - Country:US
Mailing Address - Phone:757-465-3933
Mailing Address - Fax:757-465-3944
Practice Address - Street 1:4016 RAINTREE RD
Practice Address - Street 2:SUITE 220B
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3700
Practice Address - Country:US
Practice Address - Phone:757-465-3933
Practice Address - Fax:757-465-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities