Healthcare Provider Details

I. General information

NPI: 1124807896
Provider Name (Legal Business Name): MAIDEN'S EMBRACE ABA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10985 PACIFIC POINT PL UNIT 1203
SAN DIEGO CA
92129-2088
US

IV. Provider business mailing address

10985 PACIFIC POINT PL UNIT 1203
SAN DIEGO CA
92129-2088
US

V. Phone/Fax

Practice location:
  • Phone: 858-253-0809
  • Fax: 858-261-0057
Mailing address:
  • Phone: 858-253-0809
  • Fax: 858-261-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: IFAH S GRADY
Title or Position: PRESIDENT
Credential: BCBA
Phone: 858-253-0809