MEDICARE: TOTAL CARE ABA IN 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	:	1518626837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CARE ABA IN LLC

Provider Business Mailing Address
First Line	:	120 E MARKET ST STE 1267
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3250
Country	:	US
Telephone Number	:	404-400-5004
Fax Number	:	404-400-5003

Provider Business Practice Location Address
First Line	:	120 E MARKET ST STE 1267
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-3250
Country	:	US
Telephone Number	:	404-400-5004
Fax Number	:	404-400-5003

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	02/16/2022

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