Provider Demographics
NPI:1902046725
Name:THE RICH CENTER FOR AUTISM @YSU
Entity Type:Organization
Organization Name:THE RICH CENTER FOR AUTISM @YSU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:J.
Authorized Official - Middle Name:GEORGIA
Authorized Official - Last Name:BACKUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-941-4669
Mailing Address - Street 1:ONE UNIVERSITY PLAZA
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44555
Mailing Address - Country:US
Mailing Address - Phone:330-941-1927
Mailing Address - Fax:330-941-4670
Practice Address - Street 1:ONE UNIVERSITY PLAZA
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44555
Practice Address - Country:US
Practice Address - Phone:330-941-1927
Practice Address - Fax:330-941-4670
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNGSTOWN STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH294860851103K00000X
OHOT-05585225X00000X
SP8310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty