Provider Demographics
NPI:1487941837
Name:AUTISM SERVICES NORTH
Entity type:Organization
Organization Name:AUTISM SERVICES NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCHBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-306-8602
Mailing Address - Street 1:5 RIDGEMONT CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1222
Mailing Address - Country:US
Mailing Address - Phone:313-414-9969
Mailing Address - Fax:
Practice Address - Street 1:5 RIDGEMONT CT
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1222
Practice Address - Country:US
Practice Address - Phone:313-414-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization