Provider Demographics
NPI:1215105663
Name:CHILDREN'S AUTISM CENTER, INC
Entity type:Organization
Organization Name:CHILDREN'S AUTISM CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:FORTE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:260-459-6040
Mailing Address - Street 1:6208 CONSTITUTION DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-1585
Mailing Address - Country:US
Mailing Address - Phone:260-459-6040
Mailing Address - Fax:260-459-6010
Practice Address - Street 1:6208 CONSTITUTION DR STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1585
Practice Address - Country:US
Practice Address - Phone:260-459-6040
Practice Address - Fax:260-459-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities