Provider Demographics
NPI:1861162034
Name:CORYELL AUTISM CENTER
Entity type:Organization
Organization Name:CORYELL AUTISM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GEIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-440-0345
Mailing Address - Street 1:111 ERRETT CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5920
Mailing Address - Country:US
Mailing Address - Phone:831-713-5186
Mailing Address - Fax:
Practice Address - Street 1:111 ERRETT CIR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5920
Practice Address - Country:US
Practice Address - Phone:831-713-5186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services