Basic Information
| Provider Information | |||||||||
| NPI: | 1356508030 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE AUTISM CENTER, INC, | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40485 MURRIETA HOT SPRINGS RD | ||||||||
| Address2: | B-4, #146 | ||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925636436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518134034 | ||||||||
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| Practice Location | |||||||||
| Address1: | 41951 REMINGTON AVE | ||||||||
| Address2: | STE 210 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925902552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518134034 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| AuthorizedOfficialLastName: | MACKEN | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9518134034 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | M.A., B.C.B.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1052486 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.