Provider Demographics
NPI:1417788589
Name:COMMONWEALTH AUTISM CARE
Entity type:Organization
Organization Name:COMMONWEALTH AUTISM CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:877-498-0319
Mailing Address - Street 1:6900 HOUSTON RD STE 19
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-4890
Mailing Address - Country:US
Mailing Address - Phone:859-620-0041
Mailing Address - Fax:
Practice Address - Street 1:125 REARDON BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2034
Practice Address - Country:US
Practice Address - Phone:877-498-0319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health