Healthcare Provider Details

I. General information

NPI: 1114780848
Provider Name (Legal Business Name): ACHIEVE ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W SPLIT ROCK FALLS DR
TAYLOR AZ
85939-2712
US

IV. Provider business mailing address

510 W RODEO RD
SNOWFLAKE AZ
85937-0709
US

V. Phone/Fax

Practice location:
  • Phone: 801-859-4087
  • Fax:
Mailing address:
  • Phone: 801-859-4087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRYAN PATEL
Title or Position: CEO
Credential:
Phone: 801-859-4087