Provider Demographics
NPI:1538790720
Name:MISSION AUTISM CLINICS LLC
Entity type:Organization
Organization Name:MISSION AUTISM CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:DEANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-401-6409
Mailing Address - Street 1:9 BANKS AVE
Mailing Address - Street 2:
Mailing Address - City:MCADOO
Mailing Address - State:PA
Mailing Address - Zip Code:18237-2508
Mailing Address - Country:US
Mailing Address - Phone:570-459-2889
Mailing Address - Fax:
Practice Address - Street 1:11921 BOURNEFIELD WAY STE A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7815
Practice Address - Country:US
Practice Address - Phone:888-726-4774
Practice Address - Fax:570-362-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty