Provider Demographics
NPI:1154060689
Name:AUTISM SPECIALTY GROUP LLC
Entity type:Organization
Organization Name:AUTISM SPECIALTY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RONACHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-553-6663
Mailing Address - Street 1:PO BOX 12618
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33101-2618
Mailing Address - Country:US
Mailing Address - Phone:305-767-1924
Mailing Address - Fax:305-673-5917
Practice Address - Street 1:144 NW 37TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3111
Practice Address - Country:US
Practice Address - Phone:305-767-1924
Practice Address - Fax:305-673-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-02
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016704400Medicaid