MEDICARE: KIDS RISE ABA THERAPY 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	:	1881214211
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS RISE ABA THERAPY LLC

Provider Business Mailing Address
First Line	:	6747 SILVER SAGE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1840
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6747 SILVER SAGE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-1840
Country	:	US
Telephone Number	:	201-654-2396
Fax Number	:

Authorized Official
Title or Position	:	BCBA
Name	:	ANABELL REGUEIRA
Credential	:	BCBA
Telephone Number	:	201-654-2396

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	03/31/2023

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Directions to “KIDS RISE ABA THERAPY LLC ” Practice Location

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