Provider Demographics
NPI:1578173472
Name:AUTISM LEARNING COLLABORATIVE LLC
Entity type:Organization
Organization Name:AUTISM LEARNING COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT AND CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GELENE ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALINO
Authorized Official - Suffix:
Authorized Official - Credentials:CBCS,PESC
Authorized Official - Phone:916-280-3936
Mailing Address - Street 1:8300 JEFFERSON ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1734
Mailing Address - Country:US
Mailing Address - Phone:844-743-6506
Mailing Address - Fax:
Practice Address - Street 1:8300 JEFFERSON ST NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1734
Practice Address - Country:US
Practice Address - Phone:531-272-2412
Practice Address - Fax:531-777-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty