Organization
NORTHSHORE AUTISM CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHAD FAVRE M.S., BCBA, LBA (DIRECTOR)
(985) 502-1884
Entity
Organization
Contact information
Practice address
800 JACKSON AVE, MANDEVILLE, LA 70448-5328
(985) 502-1884
(504) 617-7811
Mailing address
345 FOREST BROOK BLVD, MANDEVILLE, LA 70448-8474
(985) 502-1884
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
12/09/2016
Last updated
06/03/2020
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