MEDICARE: ABOVE AND BEYOND MILESTONES DEVELOPMENT CENTER GK LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114763752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABOVE AND BEYOND MILESTONES DEVELOPMENT CENTER GK LLC

Provider Business Mailing Address
First Line	:	1-796 CHATAN-CHO MIYAGI
Second Line	:	PORTSIDE TOWN 3A
City	:	CHATAN
State	:	OKINAWA PERFECTURE
Zip	:	9040113
Country	:	JP
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1-796 CHATAN-CHO MIYAGI
Second Line	:	PORTSIDE TOWN 3A
City	:	CHATAN
State	:	OKINAWA PERFECTURE
Zip	:	9040113
Country	:	JP
Telephone Number	:	708-944-3435
Fax Number	:

Authorized Official
Title or Position	:	CO-CEO
Name	:	LILIT DEJANIRA SALAZAR
Credential	:	BCBA
Telephone Number	:	818-433-2351

Provider Enumeration Date	:	07/03/2024
Last Update Date	:	07/07/2024

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