Healthcare Provider Details

I. General information

NPI: 1215646245
Provider Name (Legal Business Name): BRIDGECARE ABA AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 03/30/2025
Certification Date: 03/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N CENTRAL AVE
PHOENIX AZ
85004-2322
US

IV. Provider business mailing address

3600 ROUTE 66 STE 150
NEPTUNE NJ
07753-2645
US

V. Phone/Fax

Practice location:
  • Phone: 602-666-9988
  • Fax:
Mailing address:
  • Phone: 201-676-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALAN MARK HOLLANDER
Title or Position: DIRECTOR
Credential:
Phone: 201-676-2579