Provider Demographics
NPI:1063211506
Name:AUTONOMOUS USER REHABILITATION AGENT, LLC
Entity type:Organization
Organization Name:AUTONOMOUS USER REHABILITATION AGENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEVREMOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-200-7753
Mailing Address - Street 1:8033 W SUNSET BLVD STE 353
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2401
Mailing Address - Country:US
Mailing Address - Phone:310-200-7753
Mailing Address - Fax:
Practice Address - Street 1:5757 W CENTURY BLVD STE 700-55
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6401
Practice Address - Country:US
Practice Address - Phone:310-200-7753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care