MEDICARE: ABA TOTAL CARE CO 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1144185091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABA TOTAL CARE CO LLC

Provider Business Mailing Address
First Line	:	1624 BONFORTE BLVD STE 1624D4
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-1679
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1624 BONFORTE BLVD STE 1624D4
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-1679
Country	:	US
Telephone Number	:	404-400-5004
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUBEN KESHERIM
Credential	:
Telephone Number	:	404-400-5004

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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