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NPI Code Detail

MEDICARE: BLUE ABA ARIZONA LLC

MEDICARE: BLUE ABA ARIZONA 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1255038667
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE ABA ARIZONA LLC
Provider Business Mailing Address
First Line : 3921 ALTON RD UNIT 107
Second Line :
City : MIAMI BEACH
State : FL
Zip : 33140-3852
Country : US
Telephone Number : 786-521-1587
Fax Number :
Provider Business Practice Location Address
First Line : 4600 E WASHINGTON ST STE 300
Second Line :
City : PHOENIX
State : AZ
Zip : 85034-1908
Country : US
Telephone Number : 623-335-4283
Fax Number :
Authorized Official
Title or Position : CEO
Name : GERSHON FINK
Credential :
Telephone Number : 786-521-1587
Provider Enumeration Date : 02/15/2023
Last Update Date : 03/18/2026

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