Provider Demographics
NPI:1386460269
Name:BLUEPRINT AUTISM SERVICES LLC
Entity type:Organization
Organization Name:BLUEPRINT AUTISM SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEADING
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:260-243-2256
Mailing Address - Street 1:8110 M 186
Mailing Address - Street 2:
Mailing Address - City:FIFE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49633-9733
Mailing Address - Country:US
Mailing Address - Phone:260-243-2256
Mailing Address - Fax:
Practice Address - Street 1:8110 M 186
Practice Address - Street 2:
Practice Address - City:FIFE LAKE
Practice Address - State:MI
Practice Address - Zip Code:49633-9733
Practice Address - Country:US
Practice Address - Phone:260-243-2256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities